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.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Wills Memorial Hospital,1/17/2025,2.0.0,Wills Memorial Hospital,"120 Gordon St, Washington, GA 30673",582036813,TRUE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
description,code|1,code|1|type,code|2,code|2|type,code|3,code|3|type,setting,drug_unit_of_measurement,drug_type_of_measurement,standard_charge|gross,standard_charge|discounted_cash,modifiers,standard_charge|Aetna|Commercial|negotiated_dollar,standard_charge|Aetna|Commercial|negotiated_percentage,standard_charge|Aetna|Commercial|negotiated_algorithm,estimated_amount|Aetna|Commercial,standard_charge|Aetna|Commercial|methodology,additional_payer_notes|Aetna|Commercial,standard_charge|AMERIGROUP MEDICAID|MEDICAID|negotiated_dollar,standard_charge|AMERIGROUP MEDICAID|MEDICAID|negotiated_percentage,standard_charge|AMERIGROUP MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|AMERIGROUP MEDICAID|MEDICAID,standard_charge|AMERIGROUP MEDICAID|MEDICAID|methodology,additional_payer_notes|AMERIGROUP MEDICAID|MEDICAID,standard_charge|ANTHEM BCBS MEDICARE|MEDICARE|negotiated_dollar,standard_charge|ANTHEM BCBS MEDICARE|MEDICARE|negotiated_percentage,standard_charge|ANTHEM BCBS MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|ANTHEM BCBS MEDICARE|MEDICARE,standard_charge|ANTHEM BCBS MEDICARE|MEDICARE|methodology,additional_payer_notes|ANTHEM BCBS MEDICARE|MEDICARE,standard_charge|CARESOURCE MEDICAID|MEDICAID|negotiated_dollar,standard_charge|CARESOURCE MEDICAID|MEDICAID|negotiated_percentage,standard_charge|CARESOURCE MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|CARESOURCE MEDICAID|MEDICAID,standard_charge|CARESOURCE MEDICAID|MEDICAID|methodology,additional_payer_notes|CARESOURCE MEDICAID|MEDICAID,standard_charge|CIGNA|Commercial|negotiated_dollar,standard_charge|CIGNA|Commercial|negotiated_percentage,standard_charge|CIGNA|Commercial|negotiated_algorithm,estimated_amount|CIGNA|Commercial,standard_charge|CIGNA|Commercial|methodology,additional_payer_notes|CIGNA|Commercial,standard_charge|HUMANA|Commercial|negotiated_dollar,standard_charge|HUMANA|Commercial|negotiated_percentage,standard_charge|HUMANA|Commercial|negotiated_algorithm,estimated_amount|HUMANA|Commercial,standard_charge|HUMANA|Commercial|methodology,additional_payer_notes|HUMANA|Commercial,standard_charge|HUMANA MEDICARE|MEDICARE|negotiated_dollar,standard_charge|HUMANA MEDICARE|MEDICARE|negotiated_percentage,standard_charge|HUMANA MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|HUMANA MEDICARE|MEDICARE,standard_charge|HUMANA MEDICARE|MEDICARE|methodology,additional_payer_notes|HUMANA MEDICARE|MEDICARE,standard_charge|MEDICAID|MEDICAID|negotiated_dollar,standard_charge|MEDICAID|MEDICAID|negotiated_percentage,standard_charge|MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|MEDICAID|MEDICAID,standard_charge|MEDICAID|MEDICAID|methodology,additional_payer_notes|MEDICAID|MEDICAID,standard_charge|MEDICARE|MEDICARE|negotiated_dollar,standard_charge|MEDICARE|MEDICARE|negotiated_percentage,standard_charge|MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|MEDICARE|MEDICARE,standard_charge|MEDICARE|MEDICARE|methodology,additional_payer_notes|MEDICARE|MEDICARE,standard_charge|PEACHSTATE MEDICAID|MEDICAID|negotiated_dollar,standard_charge|PEACHSTATE MEDICAID|MEDICAID|negotiated_percentage,standard_charge|PEACHSTATE MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|PEACHSTATE MEDICAID|MEDICAID,standard_charge|PEACHSTATE MEDICAID|MEDICAID|methodology,additional_payer_notes|PEACHSTATE MEDICAID|MEDICAID,standard_charge|PRUITTHEALTH PREMIER|MEDICARE|negotiated_dollar,standard_charge|PRUITTHEALTH PREMIER|MEDICARE|negotiated_percentage,standard_charge|PRUITTHEALTH PREMIER|MEDICARE|negotiated_algorithm,estimated_amount|PRUITTHEALTH PREMIER|MEDICARE,standard_charge|PRUITTHEALTH PREMIER|MEDICARE|methodology,additional_payer_notes|PRUITTHEALTH PREMIER|MEDICARE,standard_charge|UHC|Commercial|negotiated_dollar,standard_charge|UHC|Commercial|negotiated_percentage,standard_charge|UHC|Commercial|negotiated_algorithm,estimated_amount|UHC|Commercial,standard_charge|UHC|Commercial|methodology,additional_payer_notes|UHC|Commercial,standard_charge|UHC MEDICARE|MEDICARE|negotiated_dollar,standard_charge|UHC MEDICARE|MEDICARE|negotiated_percentage,standard_charge|UHC MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|UHC MEDICARE|MEDICARE,standard_charge|UHC MEDICARE|MEDICARE|methodology,additional_payer_notes|UHC MEDICARE|MEDICARE,standard_charge|WELLCARE|MEDICARE|negotiated_dollar,standard_charge|WELLCARE|MEDICARE|negotiated_percentage,standard_charge|WELLCARE|MEDICARE|negotiated_algorithm,estimated_amount|WELLCARE|MEDICARE,standard_charge|WELLCARE|MEDICARE|methodology,additional_payer_notes|WELLCARE|MEDICARE,standard_charge|min,standard_charge|max,additional_generic_notes
ROOM/BED: Swing Bed,10034,CDM,110,RC,,,Inpatient,,,306,214.2,,244.8,80,,195.84,percent of total Billed Charges,80% of Total Billed Charges,,,,,Other,Not Separately reimbursable,2293.5,100,,,per diem,pays based on per day rate ,,,,,Other,Not Separately reimbursable,260.1,85,,208.08,percent of total Billed Charges,85% of total Billed Charges,244.8,80,,195.84,percent of total Billed Charges,80% of total Billed Charges,2293.5,100,,,per diem,pays based on per day rate,,,,,Other,Not Separately reimbursable,2293.5,100,,,per diem,pays based on per day rate,,,,,Other,Not Separately reimbursable,2293.5,100,,,per diem,pays based on per day rate,244.8,80,,195.84,percent of total Billed Charges,80% of Total Billed Charges,2293.5,100,,,per diem,pays based on per day rate,2293.5,100,,,per diem,pays based on per day rate,244.8,2293.5,
ROOM/BED: Hospice,10017,CDM,111,RC,,,Inpatient,,,510,357,,408,80,,326.4,percent of total Billed Charges,80% of Total Billed Charges,,,,,Other,Not Separately reimbursable,2293.5,100,,,per diem,pays based on per day rate ,,,,,Other,Not Separately reimbursable,433.5,85,,346.8,percent of total Billed Charges,85% of total Billed Charges,408,80,,326.4,percent of total Billed Charges,80% of total Billed Charges,2293.5,100,,,per diem,pays based on per day rate,,,,,Other,Not Separately reimbursable,2293.5,100,,,per diem,pays based on per day rate,,,,,Other,Not Separately reimbursable,2293.5,100,,,per diem,pays based on per day rate,408,80,,326.4,percent of total Billed Charges,80% of Total Billed Charges,2293.5,100,,,per diem,pays based on per day rate,2293.5,100,,,per diem,pays based on per day rate,408,2293.5,
ROOM/BED: Inpatient,10017,CDM,111,RC,,,Inpatient,,,510,357,,408,80,,326.4,percent of total Billed Charges,80% of Total Billed Charges,,,,,Other,Not Separately reimbursable,2293.5,100,,,per diem,pays based on per day rate ,,,,,Other,Not Separately reimbursable,433.5,85,,346.8,percent of total Billed Charges,85% of total Billed Charges,408,80,,326.4,percent of total Billed Charges,80% of total Billed Charges,2293.5,100,,,per diem,pays based on per day rate,,,,,Other,Not Separately reimbursable,2293.5,100,,,per diem,pays based on per day rate,,,,,Other,Not Separately reimbursable,2293.5,100,,,per diem,pays based on per day rate,408,80,,326.4,percent of total Billed Charges,80% of Total Billed Charges,2293.5,100,,,per diem,pays based on per day rate,2293.5,100,,,per diem,pays based on per day rate,408,2293.5,
ROOM/BED: Intermediate,10022,CDM,111,RC,,,Inpatient,,,1224,856.8,,979.2,80,,783.36,percent of total Billed Charges,80% of Total Billed Charges,,,,,Other,Not Separately reimbursable,2293.5,100,,,per diem,pays based on per day rate ,,,,,Other,Not Separately reimbursable,1040.4,85,,832.32,percent of total Billed Charges,85% of total Billed Charges,979.2,80,,783.36,percent of total Billed Charges,80% of total Billed Charges,2293.5,100,,,per diem,pays based on per day rate,,,,,Other,Not Separately reimbursable,2293.5,100,,,per diem,pays based on per day rate,,,,,Other,Not Separately reimbursable,2293.5,100,,,per diem,pays based on per day rate,979.2,80,,783.36,percent of total Billed Charges,80% of Total Billed Charges,2293.5,100,,,per diem,pays based on per day rate,2293.5,100,,,per diem,pays based on per day rate,979.2,2293.5,
ROOM/BED: Respite,10017,CDM,111,RC,,,Inpatient,,,510,357,,408,80,,326.4,percent of total Billed Charges,80% of Total Billed Charges,,,,,Other,Not Separately reimbursable,2293.5,100,,,per diem,pays based on per day rate ,,,,,Other,Not Separately reimbursable,433.5,85,,346.8,percent of total Billed Charges,85% of total Billed Charges,408,80,,326.4,percent of total Billed Charges,80% of total Billed Charges,2293.5,100,,,per diem,pays based on per day rate,,,,,Other,Not Separately reimbursable,2293.5,100,,,per diem,pays based on per day rate,,,,,Other,Not Separately reimbursable,2293.5,100,,,per diem,pays based on per day rate,408,80,,326.4,percent of total Billed Charges,80% of Total Billed Charges,2293.5,100,,,per diem,pays based on per day rate,2293.5,100,,,per diem,pays based on per day rate,408,2293.5,
insulin regular human recombinant 100 units/100 mL,193705,CDM,250,RC,J1815,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.32,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.31,0.32,
Sodi0.9Sol,,,250,RC,J7040,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.35,1.38,
magnesium sulfate 10 mg/mL D5W 100 mL [WLMH],193234,CDM,250,RC,J3475,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.69,0.7,
test333,193234,CDM,250,RC,J3475,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.69,0.7,
EPINEPHrine 1 mg/mL Nebulized,103000000,CDM,250,RC,J0171,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.75,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.77,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.75,0.77,
Respiratory syncytial virus,,,250,RC,90732,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,133.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,133.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,133.47,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,136.14,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,133.47,136.14,
Respiratory syncytial virus,,,250,RC,90714,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,30.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,30.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.34,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,30.95,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,30.34,30.95,
Respiratory syncytial virus,,,250,RC,90714,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,30.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,30.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.34,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,30.95,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,30.34,30.95,
Respiratory syncytial virus,,,250,RC,90714,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,30.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,30.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,30.34,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,30.95,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,30.34,30.95,
Respiratory syncytial virus,,,250,RC,90686,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,22.8,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,22.35,22.8,
Respiratory syncytial virus,,,250,RC,90686,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,22.8,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,22.35,22.8,
Respiratory syncytial virus,,,250,RC,90686,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,22.8,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,22.35,22.8,
Respiratory syncytial virus,,,250,RC,90746,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,70.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,70.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,70.38,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,71.79,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,70.38,71.79,
Respiratory syncytial virus,,,250,RC,90746,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,70.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,70.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,70.38,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,71.79,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,70.38,71.79,
dextrose 5% with 0.9% NaCl IV Soln 1000 mL [WLMH],160019,CDM,258,RC,J7042,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.59,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.62,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.59,1.62,
Lactated Ringers IV Soln 1000 mL [WLMH],160031,CDM,258,RC,J7120,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,2.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,2.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.59,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,2.64,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,2.59,2.64,
test131,160025,CDM,258,RC,J7060,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.93,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.97,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.93,1.97,
test130,160024,CDM,258,RC,J7070,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,3.86,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,3.86,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.86,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,3.94,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,3.86,3.94,
dextrose 5% in water IV Soln 100 mL [WLMH],160023,CDM,258,RC,J7060,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.93,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.97,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.93,1.97,
test489,160037,CDM,258,RC,J7050,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.67,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.68,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.67,0.68,
test491,160046,CDM,258,RC,J7040,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.35,1.38,
test488,160036,CDM,258,RC,J7030,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,2.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,2.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,2.74,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,2.69,2.74,
dextrose 5% with 0.9% NaCl IV Soln 1000 mL [WLMH],160019,CDM,258,RC,J7042,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.59,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.62,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.59,1.62,
test282,160031,CDM,258,RC,J7120,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,2.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,2.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.59,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,2.64,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,2.59,2.64,
sodium chloride 0.9% with KCl 40 mEq/L IV Soln 100,160093,CDM,258,RC,J3480,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.12,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.12,0.12,
test493,160093,CDM,258,RC,J3480,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.12,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.12,0.12,
hepaSol,160069,CDM,258,RC,J1644,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.27,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.28,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.27,0.28,
test132,160027,CDM,258,RC,J7060,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.93,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.97,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.93,1.97,
test129,160023,CDM,258,RC,J7060,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.93,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.97,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.93,1.97,
dextrose 5% in water IV Soln 500 mL [WLMH],160027,CDM,258,RC,J7060,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.93,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.97,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.93,1.97,
sodium chloride 0.9% IV Soln 250 mL [WLMH],160037,CDM,258,RC,J7050,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.67,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.68,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.67,0.68,
36591 BLOOD COLLECTED VIA IMPLANTED DEVICE,220158,CDM,260,RC,36591,HCPCS,Outpatient,,,165,115.5,,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,103.95,63,,83.16,percent of total Billed charges,63% of Total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total BIlled charges,103.95,63,,83.16,percent of total Billed Charges,63% of total Billed Charges,140.25,85,,112.2,percent of total Billed Charges,85% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,103.95,63,,83.16,percent of total Billed Charges,63% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,103.95,63,,83.16,percent of total billed charges,63% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,102.3,140.25,
96360 IV INF HYDRATION 31 MIN TO 1HR CHARGE,10051,CDM,260,RC,96360,HCPCS,Outpatient,,,216,151.2,,172.8,80,,138.24,percent of total Billed Charges,80% of Total Billed Charges,136.08,63,,108.864,percent of total Billed charges,63% of Total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total BIlled charges,136.08,63,,108.864,percent of total Billed Charges,63% of total Billed Charges,183.6,85,,146.88,percent of total Billed Charges,85% of total Billed Charges,172.8,80,,138.24,percent of total Billed Charges,80% of total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total Billed Charges,136.08,63,,108.864,percent of total Billed Charges,63% of total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total Billed Charges,136.08,63,,108.864,percent of total billed charges,63% of total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total Billed Charges,172.8,80,,138.24,percent of total Billed Charges,80% of Total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total Billed Charges,133.92,183.6,
96361 IV INF HYDRATION EA ADD'L HR CHARGE,10079,CDM,260,RC,96361,HCPCS,Outpatient,,,60,42,,48,80,,38.4,percent of total Billed Charges,80% of Total Billed Charges,37.8,63,,30.24,percent of total Billed charges,63% of Total Billed Charges,37.2,62,,29.76,percent of total Billed Charges,62% of total BIlled charges,37.8,63,,30.24,percent of total Billed Charges,63% of total Billed Charges,51,85,,40.8,percent of total Billed Charges,85% of total Billed Charges,48,80,,38.4,percent of total Billed Charges,80% of total Billed Charges,37.2,62,,29.76,percent of total Billed Charges,62% of total Billed Charges,37.8,63,,30.24,percent of total Billed Charges,63% of total Billed Charges,37.2,62,,29.76,percent of total Billed Charges,62% of total Billed Charges,37.8,63,,30.24,percent of total billed charges,63% of total Billed Charges,37.2,62,,29.76,percent of total Billed Charges,62% of total Billed Charges,48,80,,38.4,percent of total Billed Charges,80% of Total Billed Charges,37.2,62,,29.76,percent of total Billed Charges,62% of total Billed Charges,37.2,62,,29.76,percent of total Billed Charges,62% of total Billed Charges,37.2,51,
96365 IV INFUSION 1ST HOUR CHARGE,10088,CDM,260,RC,96365,HCPCS,Outpatient,,,352,246.4,,281.6,80,,225.28,percent of total Billed Charges,80% of Total Billed Charges,221.76,63,,177.408,percent of total Billed charges,63% of Total Billed Charges,218.24,62,,174.592,percent of total Billed Charges,62% of total BIlled charges,221.76,63,,177.408,percent of total Billed Charges,63% of total Billed Charges,299.2,85,,239.36,percent of total Billed Charges,85% of total Billed Charges,281.6,80,,225.28,percent of total Billed Charges,80% of total Billed Charges,218.24,62,,174.592,percent of total Billed Charges,62% of total Billed Charges,221.76,63,,177.408,percent of total Billed Charges,63% of total Billed Charges,218.24,62,,174.592,percent of total Billed Charges,62% of total Billed Charges,221.76,63,,177.408,percent of total billed charges,63% of total Billed Charges,218.24,62,,174.592,percent of total Billed Charges,62% of total Billed Charges,281.6,80,,225.28,percent of total Billed Charges,80% of Total Billed Charges,218.24,62,,174.592,percent of total Billed Charges,62% of total Billed Charges,218.24,62,,174.592,percent of total Billed Charges,62% of total Billed Charges,218.24,299.2,
96366 IV INFUSION ADD'L HR CHARGE,10089,CDM,260,RC,96366,HCPCS,Outpatient,,,61,42.7,,48.8,80,,39.04,percent of total Billed Charges,80% of Total Billed Charges,38.43,63,,30.744,percent of total Billed charges,63% of Total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total BIlled charges,38.43,63,,30.744,percent of total Billed Charges,63% of total Billed Charges,51.85,85,,41.48,percent of total Billed Charges,85% of total Billed Charges,48.8,80,,39.04,percent of total Billed Charges,80% of total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total Billed Charges,38.43,63,,30.744,percent of total Billed Charges,63% of total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total Billed Charges,38.43,63,,30.744,percent of total billed charges,63% of total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total Billed Charges,48.8,80,,39.04,percent of total Billed Charges,80% of Total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total Billed Charges,37.82,51.85,
96367 IV INFUSION ADD'L SEQUENTIAL UP TO 1HR CHARGE,10090,CDM,260,RC,96367,HCPCS,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,56.7,63,,45.36,percent of total Billed charges,63% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total BIlled charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total billed charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,76.5,
96374 INJECTION THERAPROPDIAGN-INTERVENOUS,10063,CDM,260,RC,96374,HCPCS,Outpatient,,,216,151.2,,172.8,80,,138.24,percent of total Billed Charges,80% of Total Billed Charges,136.08,63,,108.864,percent of total Billed charges,63% of Total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total BIlled charges,136.08,63,,108.864,percent of total Billed Charges,63% of total Billed Charges,183.6,85,,146.88,percent of total Billed Charges,85% of total Billed Charges,172.8,80,,138.24,percent of total Billed Charges,80% of total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total Billed Charges,136.08,63,,108.864,percent of total Billed Charges,63% of total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total Billed Charges,136.08,63,,108.864,percent of total billed charges,63% of total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total Billed Charges,172.8,80,,138.24,percent of total Billed Charges,80% of Total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total Billed Charges,133.92,183.6,
96375 IV PUSH EA ADD'L SEQUENTIAL CHARGE,10094,CDM,260,RC,96375,HCPCS,Outpatient,,,67,46.9,,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,42.21,63,,33.768,percent of total Billed charges,63% of Total Billed Charges,41.54,62,,33.232,percent of total Billed Charges,62% of total BIlled charges,42.21,63,,33.768,percent of total Billed Charges,63% of total Billed Charges,56.95,85,,45.56,percent of total Billed Charges,85% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of total Billed Charges,41.54,62,,33.232,percent of total Billed Charges,62% of total Billed Charges,42.21,63,,33.768,percent of total Billed Charges,63% of total Billed Charges,41.54,62,,33.232,percent of total Billed Charges,62% of total Billed Charges,42.21,63,,33.768,percent of total billed charges,63% of total Billed Charges,41.54,62,,33.232,percent of total Billed Charges,62% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,41.54,62,,33.232,percent of total Billed Charges,62% of total Billed Charges,41.54,62,,33.232,percent of total Billed Charges,62% of total Billed Charges,41.54,56.95,
96376 IV PUSH EA ADD'L CHARGE,10095,CDM,260,RC,96376,HCPCS,Outpatient,,,51,35.7,,40.8,80,,32.64,percent of total Billed Charges,80% of Total Billed Charges,32.13,63,,25.704,percent of total Billed charges,63% of Total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total BIlled charges,32.13,63,,25.704,percent of total Billed Charges,63% of total Billed Charges,43.35,85,,34.68,percent of total Billed Charges,85% of total Billed Charges,40.8,80,,32.64,percent of total Billed Charges,80% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,32.13,63,,25.704,percent of total Billed Charges,63% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,32.13,63,,25.704,percent of total billed charges,63% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,40.8,80,,32.64,percent of total Billed Charges,80% of Total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,31.62,43.35,
BANATROL PLUS POWDER PACKET (BANANA),72351,CDM,270,RC,,,Outpatient,,,28.88,20.216,,23.1,80,,18.48,percent of total Billed Charges,80% of Total Billed Charges,18.19,63,,14.552,percent of total Billed charges,63% of Total Billed Charges,17.91,62,,14.328,percent of total Billed Charges,62% of total BIlled charges,18.19,63,,14.552,percent of total Billed Charges,63% of total Billed Charges,24.55,85,,19.64,percent of total Billed Charges,85% of total Billed Charges,23.1,80,,18.48,percent of total Billed Charges,80% of total Billed Charges,17.91,62,,14.328,percent of total Billed Charges,62% of total Billed Charges,18.19,63,,14.552,percent of total Billed Charges,63% of total Billed Charges,17.91,62,,14.328,percent of total Billed Charges,62% of total Billed Charges,18.19,63,,14.552,percent of total billed charges,63% of total Billed Charges,17.91,62,,14.328,percent of total Billed Charges,62% of total Billed Charges,23.1,80,,18.48,percent of total Billed Charges,80% of Total Billed Charges,17.91,62,,14.328,percent of total Billed Charges,62% of total Billed Charges,17.91,62,,14.328,percent of total Billed Charges,62% of total Billed Charges,17.91,24.55,
BENEPROTEIN ORAL POWDER PACKET,72352,CDM,270,RC,,,Outpatient,,,6.37,4.459,,5.1,80,,4.08,percent of total Billed Charges,80% of Total Billed Charges,4.01,63,,3.208,percent of total Billed charges,63% of Total Billed Charges,3.95,62,,3.16,percent of total Billed Charges,62% of total BIlled charges,4.01,63,,3.208,percent of total Billed Charges,63% of total Billed Charges,5.41,85,,4.328,percent of total Billed Charges,85% of total Billed Charges,5.1,80,,4.08,percent of total Billed Charges,80% of total Billed Charges,3.95,62,,3.16,percent of total Billed Charges,62% of total Billed Charges,4.01,63,,3.208,percent of total Billed Charges,63% of total Billed Charges,3.95,62,,3.16,percent of total Billed Charges,62% of total Billed Charges,4.01,63,,3.208,percent of total billed charges,63% of total Billed Charges,3.95,62,,3.16,percent of total Billed Charges,62% of total Billed Charges,5.1,80,,4.08,percent of total Billed Charges,80% of Total Billed Charges,3.95,62,,3.16,percent of total Billed Charges,62% of total Billed Charges,3.95,62,,3.16,percent of total Billed Charges,62% of total Billed Charges,3.95,5.41,
BENEPROTEIN ORAL POWDER PACKET,72350,CDM,270,RC,,,Outpatient,,,41.62,29.134,,33.3,80,,26.64,percent of total Billed Charges,80% of Total Billed Charges,26.22,63,,20.976,percent of total Billed charges,63% of Total Billed Charges,25.8,62,,20.64,percent of total Billed Charges,62% of total BIlled charges,26.22,63,,20.976,percent of total Billed Charges,63% of total Billed Charges,35.38,85,,28.304,percent of total Billed Charges,85% of total Billed Charges,33.3,80,,26.64,percent of total Billed Charges,80% of total Billed Charges,25.8,62,,20.64,percent of total Billed Charges,62% of total Billed Charges,26.22,63,,20.976,percent of total Billed Charges,63% of total Billed Charges,25.8,62,,20.64,percent of total Billed Charges,62% of total Billed Charges,26.22,63,,20.976,percent of total billed charges,63% of total Billed Charges,25.8,62,,20.64,percent of total Billed Charges,62% of total Billed Charges,33.3,80,,26.64,percent of total Billed Charges,80% of Total Billed Charges,25.8,62,,20.64,percent of total Billed Charges,62% of total Billed Charges,25.8,62,,20.64,percent of total Billed Charges,62% of total Billed Charges,25.8,35.38,
WLMH NACL Flush Syr 10 ml,72065,CDM,270,RC,,,Outpatient,,,15,10.5,,12,80,,9.6,percent of total Billed Charges,80% of Total Billed Charges,9.45,63,,7.56,percent of total Billed charges,63% of Total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total BIlled charges,9.45,63,,7.56,percent of total Billed Charges,63% of total Billed Charges,12.75,85,,10.2,percent of total Billed Charges,85% of total Billed Charges,12,80,,9.6,percent of total Billed Charges,80% of total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total Billed Charges,9.45,63,,7.56,percent of total Billed Charges,63% of total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total Billed Charges,9.45,63,,7.56,percent of total billed charges,63% of total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total Billed Charges,12,80,,9.6,percent of total Billed Charges,80% of Total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total Billed Charges,9.3,12.75,
WLMH Readicat-2,50052,CDM,270,RC,,,Outpatient,,,14,9.8,,11.2,80,,8.96,percent of total Billed Charges,80% of Total Billed Charges,8.82,63,,7.056,percent of total Billed charges,63% of Total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total BIlled charges,8.82,63,,7.056,percent of total Billed Charges,63% of total Billed Charges,11.9,85,,9.52,percent of total Billed Charges,85% of total Billed Charges,11.2,80,,8.96,percent of total Billed Charges,80% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.82,63,,7.056,percent of total Billed Charges,63% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.82,63,,7.056,percent of total billed charges,63% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,11.2,80,,8.96,percent of total Billed Charges,80% of Total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.68,11.9,
BENEPROTEIN ORAL POWDER PACKET,72096,CDM,270,RC,,,Outpatient,,,9,6.3,,7.2,80,,5.76,percent of total Billed Charges,80% of Total Billed Charges,5.67,63,,4.536,percent of total Billed charges,63% of Total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total BIlled charges,5.67,63,,4.536,percent of total Billed Charges,63% of total Billed Charges,7.65,85,,6.12,percent of total Billed Charges,85% of total Billed Charges,7.2,80,,5.76,percent of total Billed Charges,80% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.67,63,,4.536,percent of total Billed Charges,63% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.67,63,,4.536,percent of total billed charges,63% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,7.2,80,,5.76,percent of total Billed Charges,80% of Total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.58,7.65,
BENEPROTEIN ORAL POWDER PACKET,72242,CDM,270,RC,,,Outpatient,,,16.63,11.641,,13.3,80,,10.64,percent of total Billed Charges,80% of Total Billed Charges,10.48,63,,8.384,percent of total Billed charges,63% of Total Billed Charges,10.31,62,,8.248,percent of total Billed Charges,62% of total BIlled charges,10.48,63,,8.384,percent of total Billed Charges,63% of total Billed Charges,14.14,85,,11.312,percent of total Billed Charges,85% of total Billed Charges,13.3,80,,10.64,percent of total Billed Charges,80% of total Billed Charges,10.31,62,,8.248,percent of total Billed Charges,62% of total Billed Charges,10.48,63,,8.384,percent of total Billed Charges,63% of total Billed Charges,10.31,62,,8.248,percent of total Billed Charges,62% of total Billed Charges,10.48,63,,8.384,percent of total billed charges,63% of total Billed Charges,10.31,62,,8.248,percent of total Billed Charges,62% of total Billed Charges,13.3,80,,10.64,percent of total Billed Charges,80% of Total Billed Charges,10.31,62,,8.248,percent of total Billed Charges,62% of total Billed Charges,10.31,62,,8.248,percent of total Billed Charges,62% of total Billed Charges,10.31,14.14,
BENEPROTEIN ORAL POWDER PACKET,70030,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72104,CDM,270,RC,,,Outpatient,,,7.5,5.25,,6,80,,4.8,percent of total Billed Charges,80% of Total Billed Charges,4.73,63,,3.784,percent of total Billed charges,63% of Total Billed Charges,4.65,62,,3.72,percent of total Billed Charges,62% of total BIlled charges,4.73,63,,3.784,percent of total Billed Charges,63% of total Billed Charges,6.38,85,,5.104,percent of total Billed Charges,85% of total Billed Charges,6,80,,4.8,percent of total Billed Charges,80% of total Billed Charges,4.65,62,,3.72,percent of total Billed Charges,62% of total Billed Charges,4.73,63,,3.784,percent of total Billed Charges,63% of total Billed Charges,4.65,62,,3.72,percent of total Billed Charges,62% of total Billed Charges,4.73,63,,3.784,percent of total billed charges,63% of total Billed Charges,4.65,62,,3.72,percent of total Billed Charges,62% of total Billed Charges,6,80,,4.8,percent of total Billed Charges,80% of Total Billed Charges,4.65,62,,3.72,percent of total Billed Charges,62% of total Billed Charges,4.65,62,,3.72,percent of total Billed Charges,62% of total Billed Charges,4.65,6.38,
BENEPROTEIN ORAL POWDER PACKET,70001,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70529,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70003,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70004,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70005,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70006,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70797,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70780,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70262,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72112,CDM,270,RC,,,Outpatient,,,35,24.5,,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,22.05,63,,17.64,percent of total Billed charges,63% of Total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total BIlled charges,22.05,63,,17.64,percent of total Billed Charges,63% of total Billed Charges,29.75,85,,23.8,percent of total Billed Charges,85% of total Billed Charges,28,80,,22.4,percent of total Billed Charges,80% of total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total Billed Charges,22.05,63,,17.64,percent of total Billed Charges,63% of total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total Billed Charges,22.05,63,,17.64,percent of total billed charges,63% of total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total Billed Charges,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total Billed Charges,21.7,29.75,
BENEPROTEIN ORAL POWDER PACKET,70009,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70781,CDM,270,RC,,,Outpatient,,,18.5,12.95,,14.8,80,,11.84,percent of total Billed Charges,80% of Total Billed Charges,11.66,63,,9.328,percent of total Billed charges,63% of Total Billed Charges,11.47,62,,9.176,percent of total Billed Charges,62% of total BIlled charges,11.66,63,,9.328,percent of total Billed Charges,63% of total Billed Charges,15.73,85,,12.584,percent of total Billed Charges,85% of total Billed Charges,14.8,80,,11.84,percent of total Billed Charges,80% of total Billed Charges,11.47,62,,9.176,percent of total Billed Charges,62% of total Billed Charges,11.66,63,,9.328,percent of total Billed Charges,63% of total Billed Charges,11.47,62,,9.176,percent of total Billed Charges,62% of total Billed Charges,11.66,63,,9.328,percent of total billed charges,63% of total Billed Charges,11.47,62,,9.176,percent of total Billed Charges,62% of total Billed Charges,14.8,80,,11.84,percent of total Billed Charges,80% of Total Billed Charges,11.47,62,,9.176,percent of total Billed Charges,62% of total Billed Charges,11.47,62,,9.176,percent of total Billed Charges,62% of total Billed Charges,11.47,15.73,
BENEPROTEIN ORAL POWDER PACKET,72338,CDM,270,RC,,,Outpatient,,,56.84,39.788,,45.47,80,,36.376,percent of total Billed Charges,80% of Total Billed Charges,35.81,63,,28.648,percent of total Billed charges,63% of Total Billed Charges,35.24,62,,28.192,percent of total Billed Charges,62% of total BIlled charges,35.81,63,,28.648,percent of total Billed Charges,63% of total Billed Charges,48.31,85,,38.648,percent of total Billed Charges,85% of total Billed Charges,45.47,80,,36.376,percent of total Billed Charges,80% of total Billed Charges,35.24,62,,28.192,percent of total Billed Charges,62% of total Billed Charges,35.81,63,,28.648,percent of total Billed Charges,63% of total Billed Charges,35.24,62,,28.192,percent of total Billed Charges,62% of total Billed Charges,35.81,63,,28.648,percent of total billed charges,63% of total Billed Charges,35.24,62,,28.192,percent of total Billed Charges,62% of total Billed Charges,45.47,80,,36.376,percent of total Billed Charges,80% of Total Billed Charges,35.24,62,,28.192,percent of total Billed Charges,62% of total Billed Charges,35.24,62,,28.192,percent of total Billed Charges,62% of total Billed Charges,35.24,48.31,
BENEPROTEIN ORAL POWDER PACKET,70724,CDM,270,RC,,,Outpatient,,,7.74,5.418,,6.19,80,,4.952,percent of total Billed Charges,80% of Total Billed Charges,4.88,63,,3.904,percent of total Billed charges,63% of Total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total BIlled charges,4.88,63,,3.904,percent of total Billed Charges,63% of total Billed Charges,6.58,85,,5.264,percent of total Billed Charges,85% of total Billed Charges,6.19,80,,4.952,percent of total Billed Charges,80% of total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total Billed Charges,4.88,63,,3.904,percent of total Billed Charges,63% of total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total Billed Charges,4.88,63,,3.904,percent of total billed charges,63% of total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total Billed Charges,6.19,80,,4.952,percent of total Billed Charges,80% of Total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total Billed Charges,4.8,6.58,
BENEPROTEIN ORAL POWDER PACKET,70723,CDM,270,RC,,,Outpatient,,,7.74,5.418,,6.19,80,,4.952,percent of total Billed Charges,80% of Total Billed Charges,4.88,63,,3.904,percent of total Billed charges,63% of Total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total BIlled charges,4.88,63,,3.904,percent of total Billed Charges,63% of total Billed Charges,6.58,85,,5.264,percent of total Billed Charges,85% of total Billed Charges,6.19,80,,4.952,percent of total Billed Charges,80% of total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total Billed Charges,4.88,63,,3.904,percent of total Billed Charges,63% of total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total Billed Charges,4.88,63,,3.904,percent of total billed charges,63% of total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total Billed Charges,6.19,80,,4.952,percent of total Billed Charges,80% of Total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total Billed Charges,4.8,6.58,
BENEPROTEIN ORAL POWDER PACKET,70722,CDM,270,RC,,,Outpatient,,,7.74,5.418,,6.19,80,,4.952,percent of total Billed Charges,80% of Total Billed Charges,4.88,63,,3.904,percent of total Billed charges,63% of Total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total BIlled charges,4.88,63,,3.904,percent of total Billed Charges,63% of total Billed Charges,6.58,85,,5.264,percent of total Billed Charges,85% of total Billed Charges,6.19,80,,4.952,percent of total Billed Charges,80% of total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total Billed Charges,4.88,63,,3.904,percent of total Billed Charges,63% of total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total Billed Charges,4.88,63,,3.904,percent of total billed charges,63% of total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total Billed Charges,6.19,80,,4.952,percent of total Billed Charges,80% of Total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total Billed Charges,4.8,6.58,
BENEPROTEIN ORAL POWDER PACKET,72347,CDM,270,RC,,,Outpatient,,,7.74,5.418,,6.19,80,,4.952,percent of total Billed Charges,80% of Total Billed Charges,4.88,63,,3.904,percent of total Billed charges,63% of Total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total BIlled charges,4.88,63,,3.904,percent of total Billed Charges,63% of total Billed Charges,6.58,85,,5.264,percent of total Billed Charges,85% of total Billed Charges,6.19,80,,4.952,percent of total Billed Charges,80% of total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total Billed Charges,4.88,63,,3.904,percent of total Billed Charges,63% of total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total Billed Charges,4.88,63,,3.904,percent of total billed charges,63% of total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total Billed Charges,6.19,80,,4.952,percent of total Billed Charges,80% of Total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total Billed Charges,4.8,62,,3.84,percent of total Billed Charges,62% of total Billed Charges,4.8,6.58,
BENEPROTEIN ORAL POWDER PACKET,70012,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70013,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71766,CDM,270,RC,,,Outpatient,,,514.64,360.248,,411.71,80,,329.368,percent of total Billed Charges,80% of Total Billed Charges,324.22,63,,259.376,percent of total Billed charges,63% of Total Billed Charges,319.08,62,,255.264,percent of total Billed Charges,62% of total BIlled charges,324.22,63,,259.376,percent of total Billed Charges,63% of total Billed Charges,437.44,85,,349.952,percent of total Billed Charges,85% of total Billed Charges,411.71,80,,329.368,percent of total Billed Charges,80% of total Billed Charges,319.08,62,,255.264,percent of total Billed Charges,62% of total Billed Charges,324.22,63,,259.376,percent of total Billed Charges,63% of total Billed Charges,319.08,62,,255.264,percent of total Billed Charges,62% of total Billed Charges,324.22,63,,259.376,percent of total billed charges,63% of total Billed Charges,319.08,62,,255.264,percent of total Billed Charges,62% of total Billed Charges,411.71,80,,329.368,percent of total Billed Charges,80% of Total Billed Charges,319.08,62,,255.264,percent of total Billed Charges,62% of total Billed Charges,319.08,62,,255.264,percent of total Billed Charges,62% of total Billed Charges,319.08,437.44,
BENEPROTEIN ORAL POWDER PACKET,70661,CDM,270,RC,,,Outpatient,,,254,177.8,,203.2,80,,162.56,percent of total Billed Charges,80% of Total Billed Charges,160.02,63,,128.016,percent of total Billed charges,63% of Total Billed Charges,157.48,62,,125.984,percent of total Billed Charges,62% of total BIlled charges,160.02,63,,128.016,percent of total Billed Charges,63% of total Billed Charges,215.9,85,,172.72,percent of total Billed Charges,85% of total Billed Charges,203.2,80,,162.56,percent of total Billed Charges,80% of total Billed Charges,157.48,62,,125.984,percent of total Billed Charges,62% of total Billed Charges,160.02,63,,128.016,percent of total Billed Charges,63% of total Billed Charges,157.48,62,,125.984,percent of total Billed Charges,62% of total Billed Charges,160.02,63,,128.016,percent of total billed charges,63% of total Billed Charges,157.48,62,,125.984,percent of total Billed Charges,62% of total Billed Charges,203.2,80,,162.56,percent of total Billed Charges,80% of Total Billed Charges,157.48,62,,125.984,percent of total Billed Charges,62% of total Billed Charges,157.48,62,,125.984,percent of total Billed Charges,62% of total Billed Charges,157.48,215.9,
BENEPROTEIN ORAL POWDER PACKET,71026,CDM,270,RC,,,Outpatient,,,234.12,163.884,,187.3,80,,149.84,percent of total Billed Charges,80% of Total Billed Charges,147.5,63,,118,percent of total Billed charges,63% of Total Billed Charges,145.15,62,,116.12,percent of total Billed Charges,62% of total BIlled charges,147.5,63,,118,percent of total Billed Charges,63% of total Billed Charges,199,85,,159.2,percent of total Billed Charges,85% of total Billed Charges,187.3,80,,149.84,percent of total Billed Charges,80% of total Billed Charges,145.15,62,,116.12,percent of total Billed Charges,62% of total Billed Charges,147.5,63,,118,percent of total Billed Charges,63% of total Billed Charges,145.15,62,,116.12,percent of total Billed Charges,62% of total Billed Charges,147.5,63,,118,percent of total billed charges,63% of total Billed Charges,145.15,62,,116.12,percent of total Billed Charges,62% of total Billed Charges,187.3,80,,149.84,percent of total Billed Charges,80% of Total Billed Charges,145.15,62,,116.12,percent of total Billed Charges,62% of total Billed Charges,145.15,62,,116.12,percent of total Billed Charges,62% of total Billed Charges,145.15,199,
BENEPROTEIN ORAL POWDER PACKET,70023,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71780,CDM,270,RC,,,Outpatient,,,7,4.9,,5.6,80,,4.48,percent of total Billed Charges,80% of Total Billed Charges,4.41,63,,3.528,percent of total Billed charges,63% of Total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total BIlled charges,4.41,63,,3.528,percent of total Billed Charges,63% of total Billed Charges,5.95,85,,4.76,percent of total Billed Charges,85% of total Billed Charges,5.6,80,,4.48,percent of total Billed Charges,80% of total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,4.41,63,,3.528,percent of total Billed Charges,63% of total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,4.41,63,,3.528,percent of total billed charges,63% of total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,5.6,80,,4.48,percent of total Billed Charges,80% of Total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,4.34,5.95,
BENEPROTEIN ORAL POWDER PACKET,72131,CDM,270,RC,,,Outpatient,,,233.94,163.758,,187.15,80,,149.72,percent of total Billed Charges,80% of Total Billed Charges,147.38,63,,117.904,percent of total Billed charges,63% of Total Billed Charges,145.04,62,,116.032,percent of total Billed Charges,62% of total BIlled charges,147.38,63,,117.904,percent of total Billed Charges,63% of total Billed Charges,198.85,85,,159.08,percent of total Billed Charges,85% of total Billed Charges,187.15,80,,149.72,percent of total Billed Charges,80% of total Billed Charges,145.04,62,,116.032,percent of total Billed Charges,62% of total Billed Charges,147.38,63,,117.904,percent of total Billed Charges,63% of total Billed Charges,145.04,62,,116.032,percent of total Billed Charges,62% of total Billed Charges,147.38,63,,117.904,percent of total billed charges,63% of total Billed Charges,145.04,62,,116.032,percent of total Billed Charges,62% of total Billed Charges,187.15,80,,149.72,percent of total Billed Charges,80% of Total Billed Charges,145.04,62,,116.032,percent of total Billed Charges,62% of total Billed Charges,145.04,62,,116.032,percent of total Billed Charges,62% of total Billed Charges,145.04,198.85,
BENEPROTEIN ORAL POWDER PACKET,72345,CDM,270,RC,,,Outpatient,,,99.61,69.727,,79.69,80,,63.752,percent of total Billed Charges,80% of Total Billed Charges,62.75,63,,50.2,percent of total Billed charges,63% of Total Billed Charges,61.76,62,,49.408,percent of total Billed Charges,62% of total BIlled charges,62.75,63,,50.2,percent of total Billed Charges,63% of total Billed Charges,84.67,85,,67.736,percent of total Billed Charges,85% of total Billed Charges,79.69,80,,63.752,percent of total Billed Charges,80% of total Billed Charges,61.76,62,,49.408,percent of total Billed Charges,62% of total Billed Charges,62.75,63,,50.2,percent of total Billed Charges,63% of total Billed Charges,61.76,62,,49.408,percent of total Billed Charges,62% of total Billed Charges,62.75,63,,50.2,percent of total billed charges,63% of total Billed Charges,61.76,62,,49.408,percent of total Billed Charges,62% of total Billed Charges,79.69,80,,63.752,percent of total Billed Charges,80% of Total Billed Charges,61.76,62,,49.408,percent of total Billed Charges,62% of total Billed Charges,61.76,62,,49.408,percent of total Billed Charges,62% of total Billed Charges,61.76,84.67,
BENEPROTEIN ORAL POWDER PACKET,72342,CDM,270,RC,,,Outpatient,,,99.61,69.727,,79.69,80,,63.752,percent of total Billed Charges,80% of Total Billed Charges,62.75,63,,50.2,percent of total Billed charges,63% of Total Billed Charges,61.76,62,,49.408,percent of total Billed Charges,62% of total BIlled charges,62.75,63,,50.2,percent of total Billed Charges,63% of total Billed Charges,84.67,85,,67.736,percent of total Billed Charges,85% of total Billed Charges,79.69,80,,63.752,percent of total Billed Charges,80% of total Billed Charges,61.76,62,,49.408,percent of total Billed Charges,62% of total Billed Charges,62.75,63,,50.2,percent of total Billed Charges,63% of total Billed Charges,61.76,62,,49.408,percent of total Billed Charges,62% of total Billed Charges,62.75,63,,50.2,percent of total billed charges,63% of total Billed Charges,61.76,62,,49.408,percent of total Billed Charges,62% of total Billed Charges,79.69,80,,63.752,percent of total Billed Charges,80% of Total Billed Charges,61.76,62,,49.408,percent of total Billed Charges,62% of total Billed Charges,61.76,62,,49.408,percent of total Billed Charges,62% of total Billed Charges,61.76,84.67,
BENEPROTEIN ORAL POWDER PACKET,72344,CDM,270,RC,,,Outpatient,,,99.61,69.727,,79.69,80,,63.752,percent of total Billed Charges,80% of Total Billed Charges,62.75,63,,50.2,percent of total Billed charges,63% of Total Billed Charges,61.76,62,,49.408,percent of total Billed Charges,62% of total BIlled charges,62.75,63,,50.2,percent of total Billed Charges,63% of total Billed Charges,84.67,85,,67.736,percent of total Billed Charges,85% of total Billed Charges,79.69,80,,63.752,percent of total Billed Charges,80% of total Billed Charges,61.76,62,,49.408,percent of total Billed Charges,62% of total Billed Charges,62.75,63,,50.2,percent of total Billed Charges,63% of total Billed Charges,61.76,62,,49.408,percent of total Billed Charges,62% of total Billed Charges,62.75,63,,50.2,percent of total billed charges,63% of total Billed Charges,61.76,62,,49.408,percent of total Billed Charges,62% of total Billed Charges,79.69,80,,63.752,percent of total Billed Charges,80% of Total Billed Charges,61.76,62,,49.408,percent of total Billed Charges,62% of total Billed Charges,61.76,62,,49.408,percent of total Billed Charges,62% of total Billed Charges,61.76,84.67,
BENEPROTEIN ORAL POWDER PACKET,72343,CDM,270,RC,,,Outpatient,,,98.44,68.908,,78.75,80,,63,percent of total Billed Charges,80% of Total Billed Charges,62.02,63,,49.616,percent of total Billed charges,63% of Total Billed Charges,61.03,62,,48.824,percent of total Billed Charges,62% of total BIlled charges,62.02,63,,49.616,percent of total Billed Charges,63% of total Billed Charges,83.67,85,,66.936,percent of total Billed Charges,85% of total Billed Charges,78.75,80,,63,percent of total Billed Charges,80% of total Billed Charges,61.03,62,,48.824,percent of total Billed Charges,62% of total Billed Charges,62.02,63,,49.616,percent of total Billed Charges,63% of total Billed Charges,61.03,62,,48.824,percent of total Billed Charges,62% of total Billed Charges,62.02,63,,49.616,percent of total billed charges,63% of total Billed Charges,61.03,62,,48.824,percent of total Billed Charges,62% of total Billed Charges,78.75,80,,63,percent of total Billed Charges,80% of Total Billed Charges,61.03,62,,48.824,percent of total Billed Charges,62% of total Billed Charges,61.03,62,,48.824,percent of total Billed Charges,62% of total Billed Charges,61.03,83.67,
BENEPROTEIN ORAL POWDER PACKET,72015,CDM,270,RC,,,Outpatient,,,9,6.3,,7.2,80,,5.76,percent of total Billed Charges,80% of Total Billed Charges,5.67,63,,4.536,percent of total Billed charges,63% of Total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total BIlled charges,5.67,63,,4.536,percent of total Billed Charges,63% of total Billed Charges,7.65,85,,6.12,percent of total Billed Charges,85% of total Billed Charges,7.2,80,,5.76,percent of total Billed Charges,80% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.67,63,,4.536,percent of total Billed Charges,63% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.67,63,,4.536,percent of total billed charges,63% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,7.2,80,,5.76,percent of total Billed Charges,80% of Total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.58,7.65,
BENEPROTEIN ORAL POWDER PACKET,70831,CDM,270,RC,,,Outpatient,,,21,14.7,,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.23,63,,10.584,percent of total Billed charges,63% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total BIlled charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,17.85,85,,14.28,percent of total Billed Charges,85% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total billed charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,17.85,
BANATROL PLUS POWDER PACKET (BANANA),72297,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72330,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70020,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72298,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70526,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71052,CDM,270,RC,,,Outpatient,,,5.18,3.626,,4.14,80,,3.312,percent of total Billed Charges,80% of Total Billed Charges,3.26,63,,2.608,percent of total Billed charges,63% of Total Billed Charges,3.21,62,,2.568,percent of total Billed Charges,62% of total BIlled charges,3.26,63,,2.608,percent of total Billed Charges,63% of total Billed Charges,4.4,85,,3.52,percent of total Billed Charges,85% of total Billed Charges,4.14,80,,3.312,percent of total Billed Charges,80% of total Billed Charges,3.21,62,,2.568,percent of total Billed Charges,62% of total Billed Charges,3.26,63,,2.608,percent of total Billed Charges,63% of total Billed Charges,3.21,62,,2.568,percent of total Billed Charges,62% of total Billed Charges,3.26,63,,2.608,percent of total billed charges,63% of total Billed Charges,3.21,62,,2.568,percent of total Billed Charges,62% of total Billed Charges,4.14,80,,3.312,percent of total Billed Charges,80% of Total Billed Charges,3.21,62,,2.568,percent of total Billed Charges,62% of total Billed Charges,3.21,62,,2.568,percent of total Billed Charges,62% of total Billed Charges,3.21,4.4,
BENEPROTEIN ORAL POWDER PACKET,70523,CDM,270,RC,,,Outpatient,,,5.46,3.822,,4.37,80,,3.496,percent of total Billed Charges,80% of Total Billed Charges,3.44,63,,2.752,percent of total Billed charges,63% of Total Billed Charges,3.39,62,,2.712,percent of total Billed Charges,62% of total BIlled charges,3.44,63,,2.752,percent of total Billed Charges,63% of total Billed Charges,4.64,85,,3.712,percent of total Billed Charges,85% of total Billed Charges,4.37,80,,3.496,percent of total Billed Charges,80% of total Billed Charges,3.39,62,,2.712,percent of total Billed Charges,62% of total Billed Charges,3.44,63,,2.752,percent of total Billed Charges,63% of total Billed Charges,3.39,62,,2.712,percent of total Billed Charges,62% of total Billed Charges,3.44,63,,2.752,percent of total billed charges,63% of total Billed Charges,3.39,62,,2.712,percent of total Billed Charges,62% of total Billed Charges,4.37,80,,3.496,percent of total Billed Charges,80% of Total Billed Charges,3.39,62,,2.712,percent of total Billed Charges,62% of total Billed Charges,3.39,62,,2.712,percent of total Billed Charges,62% of total Billed Charges,3.39,4.64,
BENEPROTEIN ORAL POWDER PACKET,70790,CDM,270,RC,,,Outpatient,,,36.72,25.704,,29.38,80,,23.504,percent of total Billed Charges,80% of Total Billed Charges,23.13,63,,18.504,percent of total Billed charges,63% of Total Billed Charges,22.77,62,,18.216,percent of total Billed Charges,62% of total BIlled charges,23.13,63,,18.504,percent of total Billed Charges,63% of total Billed Charges,31.21,85,,24.968,percent of total Billed Charges,85% of total Billed Charges,29.38,80,,23.504,percent of total Billed Charges,80% of total Billed Charges,22.77,62,,18.216,percent of total Billed Charges,62% of total Billed Charges,23.13,63,,18.504,percent of total Billed Charges,63% of total Billed Charges,22.77,62,,18.216,percent of total Billed Charges,62% of total Billed Charges,23.13,63,,18.504,percent of total billed charges,63% of total Billed Charges,22.77,62,,18.216,percent of total Billed Charges,62% of total Billed Charges,29.38,80,,23.504,percent of total Billed Charges,80% of Total Billed Charges,22.77,62,,18.216,percent of total Billed Charges,62% of total Billed Charges,22.77,62,,18.216,percent of total Billed Charges,62% of total Billed Charges,22.77,31.21,
BENEPROTEIN ORAL POWDER PACKET,70021,CDM,270,RC,,,Outpatient,,,6.72,4.704,,5.38,80,,4.304,percent of total Billed Charges,80% of Total Billed Charges,4.23,63,,3.384,percent of total Billed charges,63% of Total Billed Charges,4.17,62,,3.336,percent of total Billed Charges,62% of total BIlled charges,4.23,63,,3.384,percent of total Billed Charges,63% of total Billed Charges,5.71,85,,4.568,percent of total Billed Charges,85% of total Billed Charges,5.38,80,,4.304,percent of total Billed Charges,80% of total Billed Charges,4.17,62,,3.336,percent of total Billed Charges,62% of total Billed Charges,4.23,63,,3.384,percent of total Billed Charges,63% of total Billed Charges,4.17,62,,3.336,percent of total Billed Charges,62% of total Billed Charges,4.23,63,,3.384,percent of total billed charges,63% of total Billed Charges,4.17,62,,3.336,percent of total Billed Charges,62% of total Billed Charges,5.38,80,,4.304,percent of total Billed Charges,80% of Total Billed Charges,4.17,62,,3.336,percent of total Billed Charges,62% of total Billed Charges,4.17,62,,3.336,percent of total Billed Charges,62% of total Billed Charges,4.17,5.71,
BOOST PLUS RTU VANILLA RETL 4X6X8OZ,72299,CDM,270,RC,,,Outpatient,,,39.9,27.93,,31.92,80,,25.536,percent of total Billed Charges,80% of Total Billed Charges,25.14,63,,20.112,percent of total Billed charges,63% of Total Billed Charges,24.74,62,,19.792,percent of total Billed Charges,62% of total BIlled charges,25.14,63,,20.112,percent of total Billed Charges,63% of total Billed Charges,33.92,85,,27.136,percent of total Billed Charges,85% of total Billed Charges,31.92,80,,25.536,percent of total Billed Charges,80% of total Billed Charges,24.74,62,,19.792,percent of total Billed Charges,62% of total Billed Charges,25.14,63,,20.112,percent of total Billed Charges,63% of total Billed Charges,24.74,62,,19.792,percent of total Billed Charges,62% of total Billed Charges,25.14,63,,20.112,percent of total billed charges,63% of total Billed Charges,24.74,62,,19.792,percent of total Billed Charges,62% of total Billed Charges,31.92,80,,25.536,percent of total Billed Charges,80% of Total Billed Charges,24.74,62,,19.792,percent of total Billed Charges,62% of total Billed Charges,24.74,62,,19.792,percent of total Billed Charges,62% of total Billed Charges,24.74,33.92,
BENEPROTEIN ORAL POWDER PACKET,72055,CDM,270,RC,,,Outpatient,,,31,21.7,,24.8,80,,19.84,percent of total Billed Charges,80% of Total Billed Charges,19.53,63,,15.624,percent of total Billed charges,63% of Total Billed Charges,19.22,62,,15.376,percent of total Billed Charges,62% of total BIlled charges,19.53,63,,15.624,percent of total Billed Charges,63% of total Billed Charges,26.35,85,,21.08,percent of total Billed Charges,85% of total Billed Charges,24.8,80,,19.84,percent of total Billed Charges,80% of total Billed Charges,19.22,62,,15.376,percent of total Billed Charges,62% of total Billed Charges,19.53,63,,15.624,percent of total Billed Charges,63% of total Billed Charges,19.22,62,,15.376,percent of total Billed Charges,62% of total Billed Charges,19.53,63,,15.624,percent of total billed charges,63% of total Billed Charges,19.22,62,,15.376,percent of total Billed Charges,62% of total Billed Charges,24.8,80,,19.84,percent of total Billed Charges,80% of Total Billed Charges,19.22,62,,15.376,percent of total Billed Charges,62% of total Billed Charges,19.22,62,,15.376,percent of total Billed Charges,62% of total Billed Charges,19.22,26.35,
BENEPROTEIN ORAL POWDER PACKET,50080,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,50152,CDM,270,RC,,,Outpatient,,,8.5,5.95,,6.8,80,,5.44,percent of total Billed Charges,80% of Total Billed Charges,5.36,63,,4.288,percent of total Billed charges,63% of Total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total BIlled charges,5.36,63,,4.288,percent of total Billed Charges,63% of total Billed Charges,7.23,85,,5.784,percent of total Billed Charges,85% of total Billed Charges,6.8,80,,5.44,percent of total Billed Charges,80% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.36,63,,4.288,percent of total Billed Charges,63% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.36,63,,4.288,percent of total billed charges,63% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,6.8,80,,5.44,percent of total Billed Charges,80% of Total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.27,7.23,
BENEPROTEIN ORAL POWDER PACKET,72335,CDM,270,RC,,,Outpatient,,,5.11,3.577,,4.09,80,,3.272,percent of total Billed Charges,80% of Total Billed Charges,3.22,63,,2.576,percent of total Billed charges,63% of Total Billed Charges,3.17,62,,2.536,percent of total Billed Charges,62% of total BIlled charges,3.22,63,,2.576,percent of total Billed Charges,63% of total Billed Charges,4.34,85,,3.472,percent of total Billed Charges,85% of total Billed Charges,4.09,80,,3.272,percent of total Billed Charges,80% of total Billed Charges,3.17,62,,2.536,percent of total Billed Charges,62% of total Billed Charges,3.22,63,,2.576,percent of total Billed Charges,63% of total Billed Charges,3.17,62,,2.536,percent of total Billed Charges,62% of total Billed Charges,3.22,63,,2.576,percent of total billed charges,63% of total Billed Charges,3.17,62,,2.536,percent of total Billed Charges,62% of total Billed Charges,4.09,80,,3.272,percent of total Billed Charges,80% of Total Billed Charges,3.17,62,,2.536,percent of total Billed Charges,62% of total Billed Charges,3.17,62,,2.536,percent of total Billed Charges,62% of total Billed Charges,3.17,4.34,
BENEPROTEIN ORAL POWDER PACKET,72060,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71809,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71806,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71808,CDM,270,RC,,,Outpatient,,,6,4.2,,4.8,80,,3.84,percent of total Billed Charges,80% of Total Billed Charges,3.78,63,,3.024,percent of total Billed charges,63% of Total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total BIlled charges,3.78,63,,3.024,percent of total Billed Charges,63% of total Billed Charges,5.1,85,,4.08,percent of total Billed Charges,85% of total Billed Charges,4.8,80,,3.84,percent of total Billed Charges,80% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.78,63,,3.024,percent of total Billed Charges,63% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.78,63,,3.024,percent of total billed charges,63% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,4.8,80,,3.84,percent of total Billed Charges,80% of Total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.72,5.1,
BENEPROTEIN ORAL POWDER PACKET,71807,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71757,CDM,270,RC,,,Outpatient,,,7,4.9,,5.6,80,,4.48,percent of total Billed Charges,80% of Total Billed Charges,4.41,63,,3.528,percent of total Billed charges,63% of Total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total BIlled charges,4.41,63,,3.528,percent of total Billed Charges,63% of total Billed Charges,5.95,85,,4.76,percent of total Billed Charges,85% of total Billed Charges,5.6,80,,4.48,percent of total Billed Charges,80% of total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,4.41,63,,3.528,percent of total Billed Charges,63% of total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,4.41,63,,3.528,percent of total billed charges,63% of total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,5.6,80,,4.48,percent of total Billed Charges,80% of Total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,4.34,5.95,
BENEPROTEIN ORAL POWDER PACKET,50041,CDM,270,RC,,,Outpatient,,,14.42,10.094,,11.54,80,,9.232,percent of total Billed Charges,80% of Total Billed Charges,9.08,63,,7.264,percent of total Billed charges,63% of Total Billed Charges,8.94,62,,7.152,percent of total Billed Charges,62% of total BIlled charges,9.08,63,,7.264,percent of total Billed Charges,63% of total Billed Charges,12.26,85,,9.808,percent of total Billed Charges,85% of total Billed Charges,11.54,80,,9.232,percent of total Billed Charges,80% of total Billed Charges,8.94,62,,7.152,percent of total Billed Charges,62% of total Billed Charges,9.08,63,,7.264,percent of total Billed Charges,63% of total Billed Charges,8.94,62,,7.152,percent of total Billed Charges,62% of total Billed Charges,9.08,63,,7.264,percent of total billed charges,63% of total Billed Charges,8.94,62,,7.152,percent of total Billed Charges,62% of total Billed Charges,11.54,80,,9.232,percent of total Billed Charges,80% of Total Billed Charges,8.94,62,,7.152,percent of total Billed Charges,62% of total Billed Charges,8.94,62,,7.152,percent of total Billed Charges,62% of total Billed Charges,8.94,12.26,
BENEPROTEIN ORAL POWDER PACKET,72139,CDM,270,RC,,,Outpatient,,,15.68,10.976,,12.54,80,,10.032,percent of total Billed Charges,80% of Total Billed Charges,9.88,63,,7.904,percent of total Billed charges,63% of Total Billed Charges,9.72,62,,7.776,percent of total Billed Charges,62% of total BIlled charges,9.88,63,,7.904,percent of total Billed Charges,63% of total Billed Charges,13.33,85,,10.664,percent of total Billed Charges,85% of total Billed Charges,12.54,80,,10.032,percent of total Billed Charges,80% of total Billed Charges,9.72,62,,7.776,percent of total Billed Charges,62% of total Billed Charges,9.88,63,,7.904,percent of total Billed Charges,63% of total Billed Charges,9.72,62,,7.776,percent of total Billed Charges,62% of total Billed Charges,9.88,63,,7.904,percent of total billed charges,63% of total Billed Charges,9.72,62,,7.776,percent of total Billed Charges,62% of total Billed Charges,12.54,80,,10.032,percent of total Billed Charges,80% of Total Billed Charges,9.72,62,,7.776,percent of total Billed Charges,62% of total Billed Charges,9.72,62,,7.776,percent of total Billed Charges,62% of total Billed Charges,9.72,13.33,
BENEPROTEIN ORAL POWDER PACKET,72244,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72194,CDM,270,RC,,,Outpatient,,,10.5,7.35,,8.4,80,,6.72,percent of total Billed Charges,80% of Total Billed Charges,6.62,63,,5.296,percent of total Billed charges,63% of Total Billed Charges,6.51,62,,5.208,percent of total Billed Charges,62% of total BIlled charges,6.62,63,,5.296,percent of total Billed Charges,63% of total Billed Charges,8.93,85,,7.144,percent of total Billed Charges,85% of total Billed Charges,8.4,80,,6.72,percent of total Billed Charges,80% of total Billed Charges,6.51,62,,5.208,percent of total Billed Charges,62% of total Billed Charges,6.62,63,,5.296,percent of total Billed Charges,63% of total Billed Charges,6.51,62,,5.208,percent of total Billed Charges,62% of total Billed Charges,6.62,63,,5.296,percent of total billed charges,63% of total Billed Charges,6.51,62,,5.208,percent of total Billed Charges,62% of total Billed Charges,8.4,80,,6.72,percent of total Billed Charges,80% of Total Billed Charges,6.51,62,,5.208,percent of total Billed Charges,62% of total Billed Charges,6.51,62,,5.208,percent of total Billed Charges,62% of total Billed Charges,6.51,8.93,
BENEPROTEIN ORAL POWDER PACKET,70027,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,150051,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70514,CDM,270,RC,,,Outpatient,,,7.88,5.516,,6.3,80,,5.04,percent of total Billed Charges,80% of Total Billed Charges,4.96,63,,3.968,percent of total Billed charges,63% of Total Billed Charges,4.89,62,,3.912,percent of total Billed Charges,62% of total BIlled charges,4.96,63,,3.968,percent of total Billed Charges,63% of total Billed Charges,6.7,85,,5.36,percent of total Billed Charges,85% of total Billed Charges,6.3,80,,5.04,percent of total Billed Charges,80% of total Billed Charges,4.89,62,,3.912,percent of total Billed Charges,62% of total Billed Charges,4.96,63,,3.968,percent of total Billed Charges,63% of total Billed Charges,4.89,62,,3.912,percent of total Billed Charges,62% of total Billed Charges,4.96,63,,3.968,percent of total billed charges,63% of total Billed Charges,4.89,62,,3.912,percent of total Billed Charges,62% of total Billed Charges,6.3,80,,5.04,percent of total Billed Charges,80% of Total Billed Charges,4.89,62,,3.912,percent of total Billed Charges,62% of total Billed Charges,4.89,62,,3.912,percent of total Billed Charges,62% of total Billed Charges,4.89,6.7,
BENEPROTEIN ORAL POWDER PACKET,72191,CDM,270,RC,,,Outpatient,,,85.23,59.661,,68.18,80,,54.544,percent of total Billed Charges,80% of Total Billed Charges,53.69,63,,42.952,percent of total Billed charges,63% of Total Billed Charges,52.84,62,,42.272,percent of total Billed Charges,62% of total BIlled charges,53.69,63,,42.952,percent of total Billed Charges,63% of total Billed Charges,72.45,85,,57.96,percent of total Billed Charges,85% of total Billed Charges,68.18,80,,54.544,percent of total Billed Charges,80% of total Billed Charges,52.84,62,,42.272,percent of total Billed Charges,62% of total Billed Charges,53.69,63,,42.952,percent of total Billed Charges,63% of total Billed Charges,52.84,62,,42.272,percent of total Billed Charges,62% of total Billed Charges,53.69,63,,42.952,percent of total billed charges,63% of total Billed Charges,52.84,62,,42.272,percent of total Billed Charges,62% of total Billed Charges,68.18,80,,54.544,percent of total Billed Charges,80% of Total Billed Charges,52.84,62,,42.272,percent of total Billed Charges,62% of total Billed Charges,52.84,62,,42.272,percent of total Billed Charges,62% of total Billed Charges,52.84,72.45,
BENEPROTEIN ORAL POWDER PACKET,71714,CDM,270,RC,,,Outpatient,,,9,6.3,,7.2,80,,5.76,percent of total Billed Charges,80% of Total Billed Charges,5.67,63,,4.536,percent of total Billed charges,63% of Total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total BIlled charges,5.67,63,,4.536,percent of total Billed Charges,63% of total Billed Charges,7.65,85,,6.12,percent of total Billed Charges,85% of total Billed Charges,7.2,80,,5.76,percent of total Billed Charges,80% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.67,63,,4.536,percent of total Billed Charges,63% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.67,63,,4.536,percent of total billed charges,63% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,7.2,80,,5.76,percent of total Billed Charges,80% of Total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.58,7.65,
BENEPROTEIN ORAL POWDER PACKET,71795,CDM,270,RC,,,Outpatient,,,20.5,14.35,,16.4,80,,13.12,percent of total Billed Charges,80% of Total Billed Charges,12.92,63,,10.336,percent of total Billed charges,63% of Total Billed Charges,12.71,62,,10.168,percent of total Billed Charges,62% of total BIlled charges,12.92,63,,10.336,percent of total Billed Charges,63% of total Billed Charges,17.43,85,,13.944,percent of total Billed Charges,85% of total Billed Charges,16.4,80,,13.12,percent of total Billed Charges,80% of total Billed Charges,12.71,62,,10.168,percent of total Billed Charges,62% of total Billed Charges,12.92,63,,10.336,percent of total Billed Charges,63% of total Billed Charges,12.71,62,,10.168,percent of total Billed Charges,62% of total Billed Charges,12.92,63,,10.336,percent of total billed charges,63% of total Billed Charges,12.71,62,,10.168,percent of total Billed Charges,62% of total Billed Charges,16.4,80,,13.12,percent of total Billed Charges,80% of Total Billed Charges,12.71,62,,10.168,percent of total Billed Charges,62% of total Billed Charges,12.71,62,,10.168,percent of total Billed Charges,62% of total Billed Charges,12.71,17.43,
BENEPROTEIN ORAL POWDER PACKET,71794,CDM,270,RC,,,Outpatient,,,16.98,11.886,,13.58,80,,10.864,percent of total Billed Charges,80% of Total Billed Charges,10.7,63,,8.56,percent of total Billed charges,63% of Total Billed Charges,10.53,62,,8.424,percent of total Billed Charges,62% of total BIlled charges,10.7,63,,8.56,percent of total Billed Charges,63% of total Billed Charges,14.43,85,,11.544,percent of total Billed Charges,85% of total Billed Charges,13.58,80,,10.864,percent of total Billed Charges,80% of total Billed Charges,10.53,62,,8.424,percent of total Billed Charges,62% of total Billed Charges,10.7,63,,8.56,percent of total Billed Charges,63% of total Billed Charges,10.53,62,,8.424,percent of total Billed Charges,62% of total Billed Charges,10.7,63,,8.56,percent of total billed charges,63% of total Billed Charges,10.53,62,,8.424,percent of total Billed Charges,62% of total Billed Charges,13.58,80,,10.864,percent of total Billed Charges,80% of Total Billed Charges,10.53,62,,8.424,percent of total Billed Charges,62% of total Billed Charges,10.53,62,,8.424,percent of total Billed Charges,62% of total Billed Charges,10.53,14.43,
BENEPROTEIN ORAL POWDER PACKET,72208,CDM,270,RC,,,Outpatient,,,15.5,10.85,,12.4,80,,9.92,percent of total Billed Charges,80% of Total Billed Charges,9.77,63,,7.816,percent of total Billed charges,63% of Total Billed Charges,9.61,62,,7.688,percent of total Billed Charges,62% of total BIlled charges,9.77,63,,7.816,percent of total Billed Charges,63% of total Billed Charges,13.18,85,,10.544,percent of total Billed Charges,85% of total Billed Charges,12.4,80,,9.92,percent of total Billed Charges,80% of total Billed Charges,9.61,62,,7.688,percent of total Billed Charges,62% of total Billed Charges,9.77,63,,7.816,percent of total Billed Charges,63% of total Billed Charges,9.61,62,,7.688,percent of total Billed Charges,62% of total Billed Charges,9.77,63,,7.816,percent of total billed charges,63% of total Billed Charges,9.61,62,,7.688,percent of total Billed Charges,62% of total Billed Charges,12.4,80,,9.92,percent of total Billed Charges,80% of Total Billed Charges,9.61,62,,7.688,percent of total Billed Charges,62% of total Billed Charges,9.61,62,,7.688,percent of total Billed Charges,62% of total Billed Charges,9.61,13.18,
BENEPROTEIN ORAL POWDER PACKET,50079,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71826,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,50154,CDM,270,RC,,,Outpatient,,,19.25,13.475,,15.4,80,,12.32,percent of total Billed Charges,80% of Total Billed Charges,12.13,63,,9.704,percent of total Billed charges,63% of Total Billed Charges,11.94,62,,9.552,percent of total Billed Charges,62% of total BIlled charges,12.13,63,,9.704,percent of total Billed Charges,63% of total Billed Charges,16.36,85,,13.088,percent of total Billed Charges,85% of total Billed Charges,15.4,80,,12.32,percent of total Billed Charges,80% of total Billed Charges,11.94,62,,9.552,percent of total Billed Charges,62% of total Billed Charges,12.13,63,,9.704,percent of total Billed Charges,63% of total Billed Charges,11.94,62,,9.552,percent of total Billed Charges,62% of total Billed Charges,12.13,63,,9.704,percent of total billed charges,63% of total Billed Charges,11.94,62,,9.552,percent of total Billed Charges,62% of total Billed Charges,15.4,80,,12.32,percent of total Billed Charges,80% of Total Billed Charges,11.94,62,,9.552,percent of total Billed Charges,62% of total Billed Charges,11.94,62,,9.552,percent of total Billed Charges,62% of total Billed Charges,11.94,16.36,
BENEPROTEIN ORAL POWDER PACKET,130029,CDM,270,RC,,,Outpatient,,,11.2,7.84,,8.96,80,,7.168,percent of total Billed Charges,80% of Total Billed Charges,7.06,63,,5.648,percent of total Billed charges,63% of Total Billed Charges,6.94,62,,5.552,percent of total Billed Charges,62% of total BIlled charges,7.06,63,,5.648,percent of total Billed Charges,63% of total Billed Charges,9.52,85,,7.616,percent of total Billed Charges,85% of total Billed Charges,8.96,80,,7.168,percent of total Billed Charges,80% of total Billed Charges,6.94,62,,5.552,percent of total Billed Charges,62% of total Billed Charges,7.06,63,,5.648,percent of total Billed Charges,63% of total Billed Charges,6.94,62,,5.552,percent of total Billed Charges,62% of total Billed Charges,7.06,63,,5.648,percent of total billed charges,63% of total Billed Charges,6.94,62,,5.552,percent of total Billed Charges,62% of total Billed Charges,8.96,80,,7.168,percent of total Billed Charges,80% of Total Billed Charges,6.94,62,,5.552,percent of total Billed Charges,62% of total Billed Charges,6.94,62,,5.552,percent of total Billed Charges,62% of total Billed Charges,6.94,9.52,
BENEPROTEIN ORAL POWDER PACKET,70785,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,CDM,CDM,270,RC,,,Outpatient,,,5.11,3.577,,4.09,80,,3.272,percent of total Billed Charges,80% of Total Billed Charges,3.22,63,,2.576,percent of total Billed charges,63% of Total Billed Charges,3.17,62,,2.536,percent of total Billed Charges,62% of total BIlled charges,3.22,63,,2.576,percent of total Billed Charges,63% of total Billed Charges,4.34,85,,3.472,percent of total Billed Charges,85% of total Billed Charges,4.09,80,,3.272,percent of total Billed Charges,80% of total Billed Charges,3.17,62,,2.536,percent of total Billed Charges,62% of total Billed Charges,3.22,63,,2.576,percent of total Billed Charges,63% of total Billed Charges,3.17,62,,2.536,percent of total Billed Charges,62% of total Billed Charges,3.22,63,,2.576,percent of total billed charges,63% of total Billed Charges,3.17,62,,2.536,percent of total Billed Charges,62% of total Billed Charges,4.09,80,,3.272,percent of total Billed Charges,80% of Total Billed Charges,3.17,62,,2.536,percent of total Billed Charges,62% of total Billed Charges,3.17,62,,2.536,percent of total Billed Charges,62% of total Billed Charges,3.17,4.34,
BENEPROTEIN ORAL POWDER PACKET,71041,CDM,270,RC,,,Outpatient,,,15.3,10.71,,12.24,80,,9.792,percent of total Billed Charges,80% of Total Billed Charges,9.64,63,,7.712,percent of total Billed charges,63% of Total Billed Charges,9.49,62,,7.592,percent of total Billed Charges,62% of total BIlled charges,9.64,63,,7.712,percent of total Billed Charges,63% of total Billed Charges,13.01,85,,10.408,percent of total Billed Charges,85% of total Billed Charges,12.24,80,,9.792,percent of total Billed Charges,80% of total Billed Charges,9.49,62,,7.592,percent of total Billed Charges,62% of total Billed Charges,9.64,63,,7.712,percent of total Billed Charges,63% of total Billed Charges,9.49,62,,7.592,percent of total Billed Charges,62% of total Billed Charges,9.64,63,,7.712,percent of total billed charges,63% of total Billed Charges,9.49,62,,7.592,percent of total Billed Charges,62% of total Billed Charges,12.24,80,,9.792,percent of total Billed Charges,80% of Total Billed Charges,9.49,62,,7.592,percent of total Billed Charges,62% of total Billed Charges,9.49,62,,7.592,percent of total Billed Charges,62% of total Billed Charges,9.49,13.01,
BENEPROTEIN ORAL POWDER PACKET,71040,CDM,270,RC,,,Outpatient,,,15.3,10.71,,12.24,80,,9.792,percent of total Billed Charges,80% of Total Billed Charges,9.64,63,,7.712,percent of total Billed charges,63% of Total Billed Charges,9.49,62,,7.592,percent of total Billed Charges,62% of total BIlled charges,9.64,63,,7.712,percent of total Billed Charges,63% of total Billed Charges,13.01,85,,10.408,percent of total Billed Charges,85% of total Billed Charges,12.24,80,,9.792,percent of total Billed Charges,80% of total Billed Charges,9.49,62,,7.592,percent of total Billed Charges,62% of total Billed Charges,9.64,63,,7.712,percent of total Billed Charges,63% of total Billed Charges,9.49,62,,7.592,percent of total Billed Charges,62% of total Billed Charges,9.64,63,,7.712,percent of total billed charges,63% of total Billed Charges,9.49,62,,7.592,percent of total Billed Charges,62% of total Billed Charges,12.24,80,,9.792,percent of total Billed Charges,80% of Total Billed Charges,9.49,62,,7.592,percent of total Billed Charges,62% of total Billed Charges,9.49,62,,7.592,percent of total Billed Charges,62% of total Billed Charges,9.49,13.01,
BENEPROTEIN ORAL POWDER PACKET,72073,CDM,270,RC,,,Outpatient,,,20.97,14.679,,16.78,80,,13.424,percent of total Billed Charges,80% of Total Billed Charges,13.21,63,,10.568,percent of total Billed charges,63% of Total Billed Charges,13,62,,10.4,percent of total Billed Charges,62% of total BIlled charges,13.21,63,,10.568,percent of total Billed Charges,63% of total Billed Charges,17.82,85,,14.256,percent of total Billed Charges,85% of total Billed Charges,16.78,80,,13.424,percent of total Billed Charges,80% of total Billed Charges,13,62,,10.4,percent of total Billed Charges,62% of total Billed Charges,13.21,63,,10.568,percent of total Billed Charges,63% of total Billed Charges,13,62,,10.4,percent of total Billed Charges,62% of total Billed Charges,13.21,63,,10.568,percent of total billed charges,63% of total Billed Charges,13,62,,10.4,percent of total Billed Charges,62% of total Billed Charges,16.78,80,,13.424,percent of total Billed Charges,80% of Total Billed Charges,13,62,,10.4,percent of total Billed Charges,62% of total Billed Charges,13,62,,10.4,percent of total Billed Charges,62% of total Billed Charges,13,17.82,
BENEPROTEIN ORAL POWDER PACKET,150074,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70525,CDM,270,RC,,,Outpatient,,,124,86.8,,99.2,80,,79.36,percent of total Billed Charges,80% of Total Billed Charges,78.12,63,,62.496,percent of total Billed charges,63% of Total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total BIlled charges,78.12,63,,62.496,percent of total Billed Charges,63% of total Billed Charges,105.4,85,,84.32,percent of total Billed Charges,85% of total Billed Charges,99.2,80,,79.36,percent of total Billed Charges,80% of total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total Billed Charges,78.12,63,,62.496,percent of total Billed Charges,63% of total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total Billed Charges,78.12,63,,62.496,percent of total billed charges,63% of total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total Billed Charges,99.2,80,,79.36,percent of total Billed Charges,80% of Total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total Billed Charges,76.88,105.4,
BENEPROTEIN ORAL POWDER PACKET,50150,CDM,270,RC,,,Outpatient,,,22.26,15.582,,17.81,80,,14.248,percent of total Billed Charges,80% of Total Billed Charges,14.02,63,,11.216,percent of total Billed charges,63% of Total Billed Charges,13.8,62,,11.04,percent of total Billed Charges,62% of total BIlled charges,14.02,63,,11.216,percent of total Billed Charges,63% of total Billed Charges,18.92,85,,15.136,percent of total Billed Charges,85% of total Billed Charges,17.81,80,,14.248,percent of total Billed Charges,80% of total Billed Charges,13.8,62,,11.04,percent of total Billed Charges,62% of total Billed Charges,14.02,63,,11.216,percent of total Billed Charges,63% of total Billed Charges,13.8,62,,11.04,percent of total Billed Charges,62% of total Billed Charges,14.02,63,,11.216,percent of total billed charges,63% of total Billed Charges,13.8,62,,11.04,percent of total Billed Charges,62% of total Billed Charges,17.81,80,,14.248,percent of total Billed Charges,80% of Total Billed Charges,13.8,62,,11.04,percent of total Billed Charges,62% of total Billed Charges,13.8,62,,11.04,percent of total Billed Charges,62% of total Billed Charges,13.8,18.92,
BENEPROTEIN ORAL POWDER PACKET,70196,CDM,270,RC,,,Outpatient,,,28.7,20.09,,22.96,80,,18.368,percent of total Billed Charges,80% of Total Billed Charges,18.08,63,,14.464,percent of total Billed charges,63% of Total Billed Charges,17.79,62,,14.232,percent of total Billed Charges,62% of total BIlled charges,18.08,63,,14.464,percent of total Billed Charges,63% of total Billed Charges,24.4,85,,19.52,percent of total Billed Charges,85% of total Billed Charges,22.96,80,,18.368,percent of total Billed Charges,80% of total Billed Charges,17.79,62,,14.232,percent of total Billed Charges,62% of total Billed Charges,18.08,63,,14.464,percent of total Billed Charges,63% of total Billed Charges,17.79,62,,14.232,percent of total Billed Charges,62% of total Billed Charges,18.08,63,,14.464,percent of total billed charges,63% of total Billed Charges,17.79,62,,14.232,percent of total Billed Charges,62% of total Billed Charges,22.96,80,,18.368,percent of total Billed Charges,80% of Total Billed Charges,17.79,62,,14.232,percent of total Billed Charges,62% of total Billed Charges,17.79,62,,14.232,percent of total Billed Charges,62% of total Billed Charges,17.79,24.4,
BENEPROTEIN ORAL POWDER PACKET,71097,CDM,270,RC,,,Outpatient,,,47.01,32.907,,37.61,80,,30.088,percent of total Billed Charges,80% of Total Billed Charges,29.62,63,,23.696,percent of total Billed charges,63% of Total Billed Charges,29.15,62,,23.32,percent of total Billed Charges,62% of total BIlled charges,29.62,63,,23.696,percent of total Billed Charges,63% of total Billed Charges,39.96,85,,31.968,percent of total Billed Charges,85% of total Billed Charges,37.61,80,,30.088,percent of total Billed Charges,80% of total Billed Charges,29.15,62,,23.32,percent of total Billed Charges,62% of total Billed Charges,29.62,63,,23.696,percent of total Billed Charges,63% of total Billed Charges,29.15,62,,23.32,percent of total Billed Charges,62% of total Billed Charges,29.62,63,,23.696,percent of total billed charges,63% of total Billed Charges,29.15,62,,23.32,percent of total Billed Charges,62% of total Billed Charges,37.61,80,,30.088,percent of total Billed Charges,80% of Total Billed Charges,29.15,62,,23.32,percent of total Billed Charges,62% of total Billed Charges,29.15,62,,23.32,percent of total Billed Charges,62% of total Billed Charges,29.15,39.96,
BENEPROTEIN ORAL POWDER PACKET,72196,CDM,270,RC,,,Outpatient,,,87,60.9,,69.6,80,,55.68,percent of total Billed Charges,80% of Total Billed Charges,54.81,63,,43.848,percent of total Billed charges,63% of Total Billed Charges,53.94,62,,43.152,percent of total Billed Charges,62% of total BIlled charges,54.81,63,,43.848,percent of total Billed Charges,63% of total Billed Charges,73.95,85,,59.16,percent of total Billed Charges,85% of total Billed Charges,69.6,80,,55.68,percent of total Billed Charges,80% of total Billed Charges,53.94,62,,43.152,percent of total Billed Charges,62% of total Billed Charges,54.81,63,,43.848,percent of total Billed Charges,63% of total Billed Charges,53.94,62,,43.152,percent of total Billed Charges,62% of total Billed Charges,54.81,63,,43.848,percent of total billed charges,63% of total Billed Charges,53.94,62,,43.152,percent of total Billed Charges,62% of total Billed Charges,69.6,80,,55.68,percent of total Billed Charges,80% of Total Billed Charges,53.94,62,,43.152,percent of total Billed Charges,62% of total Billed Charges,53.94,62,,43.152,percent of total Billed Charges,62% of total Billed Charges,53.94,73.95,
BENEPROTEIN ORAL POWDER PACKET,71785,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72258,CDM,270,RC,,,Outpatient,,,89.67,62.769,,71.74,80,,57.392,percent of total Billed Charges,80% of Total Billed Charges,56.49,63,,45.192,percent of total Billed charges,63% of Total Billed Charges,55.6,62,,44.48,percent of total Billed Charges,62% of total BIlled charges,56.49,63,,45.192,percent of total Billed Charges,63% of total Billed Charges,76.22,85,,60.976,percent of total Billed Charges,85% of total Billed Charges,71.74,80,,57.392,percent of total Billed Charges,80% of total Billed Charges,55.6,62,,44.48,percent of total Billed Charges,62% of total Billed Charges,56.49,63,,45.192,percent of total Billed Charges,63% of total Billed Charges,55.6,62,,44.48,percent of total Billed Charges,62% of total Billed Charges,56.49,63,,45.192,percent of total billed charges,63% of total Billed Charges,55.6,62,,44.48,percent of total Billed Charges,62% of total Billed Charges,71.74,80,,57.392,percent of total Billed Charges,80% of Total Billed Charges,55.6,62,,44.48,percent of total Billed Charges,62% of total Billed Charges,55.6,62,,44.48,percent of total Billed Charges,62% of total Billed Charges,55.6,76.22,
BENEPROTEIN ORAL POWDER PACKET,72141,CDM,270,RC,,,Outpatient,,,749.65,524.755,,599.72,80,,479.776,percent of total Billed Charges,80% of Total Billed Charges,472.28,63,,377.824,percent of total Billed charges,63% of Total Billed Charges,464.78,62,,371.824,percent of total Billed Charges,62% of total BIlled charges,472.28,63,,377.824,percent of total Billed Charges,63% of total Billed Charges,637.2,85,,509.76,percent of total Billed Charges,85% of total Billed Charges,599.72,80,,479.776,percent of total Billed Charges,80% of total Billed Charges,464.78,62,,371.824,percent of total Billed Charges,62% of total Billed Charges,472.28,63,,377.824,percent of total Billed Charges,63% of total Billed Charges,464.78,62,,371.824,percent of total Billed Charges,62% of total Billed Charges,472.28,63,,377.824,percent of total billed charges,63% of total Billed Charges,464.78,62,,371.824,percent of total Billed Charges,62% of total Billed Charges,599.72,80,,479.776,percent of total Billed Charges,80% of Total Billed Charges,464.78,62,,371.824,percent of total Billed Charges,62% of total Billed Charges,464.78,62,,371.824,percent of total Billed Charges,62% of total Billed Charges,464.78,637.2,
DIABETISOURCE AC TETRA PACK 24X8OZ,72290,CDM,270,RC,,,Outpatient,,,9.13,6.391,,7.3,80,,5.84,percent of total Billed Charges,80% of Total Billed Charges,5.75,63,,4.6,percent of total Billed charges,63% of Total Billed Charges,5.66,62,,4.528,percent of total Billed Charges,62% of total BIlled charges,5.75,63,,4.6,percent of total Billed Charges,63% of total Billed Charges,7.76,85,,6.208,percent of total Billed Charges,85% of total Billed Charges,7.3,80,,5.84,percent of total Billed Charges,80% of total Billed Charges,5.66,62,,4.528,percent of total Billed Charges,62% of total Billed Charges,5.75,63,,4.6,percent of total Billed Charges,63% of total Billed Charges,5.66,62,,4.528,percent of total Billed Charges,62% of total Billed Charges,5.75,63,,4.6,percent of total billed charges,63% of total Billed Charges,5.66,62,,4.528,percent of total Billed Charges,62% of total Billed Charges,7.3,80,,5.84,percent of total Billed Charges,80% of Total Billed Charges,5.66,62,,4.528,percent of total Billed Charges,62% of total Billed Charges,5.66,62,,4.528,percent of total Billed Charges,62% of total Billed Charges,5.66,7.76,
BENEPROTEIN ORAL POWDER PACKET,70662,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70263,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72047,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72048,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71861,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70037,CDM,270,RC,,,Outpatient,,,8.26,5.782,,6.61,80,,5.288,percent of total Billed Charges,80% of Total Billed Charges,5.2,63,,4.16,percent of total Billed charges,63% of Total Billed Charges,5.12,62,,4.096,percent of total Billed Charges,62% of total BIlled charges,5.2,63,,4.16,percent of total Billed Charges,63% of total Billed Charges,7.02,85,,5.616,percent of total Billed Charges,85% of total Billed Charges,6.61,80,,5.288,percent of total Billed Charges,80% of total Billed Charges,5.12,62,,4.096,percent of total Billed Charges,62% of total Billed Charges,5.2,63,,4.16,percent of total Billed Charges,63% of total Billed Charges,5.12,62,,4.096,percent of total Billed Charges,62% of total Billed Charges,5.2,63,,4.16,percent of total billed charges,63% of total Billed Charges,5.12,62,,4.096,percent of total Billed Charges,62% of total Billed Charges,6.61,80,,5.288,percent of total Billed Charges,80% of Total Billed Charges,5.12,62,,4.096,percent of total Billed Charges,62% of total Billed Charges,5.12,62,,4.096,percent of total Billed Charges,62% of total Billed Charges,5.12,7.02,
BENEPROTEIN ORAL POWDER PACKET,72209,CDM,270,RC,,,Outpatient,,,82.92,58.044,,66.34,80,,53.072,percent of total Billed Charges,80% of Total Billed Charges,52.24,63,,41.792,percent of total Billed charges,63% of Total Billed Charges,51.41,62,,41.128,percent of total Billed Charges,62% of total BIlled charges,52.24,63,,41.792,percent of total Billed Charges,63% of total Billed Charges,70.48,85,,56.384,percent of total Billed Charges,85% of total Billed Charges,66.34,80,,53.072,percent of total Billed Charges,80% of total Billed Charges,51.41,62,,41.128,percent of total Billed Charges,62% of total Billed Charges,52.24,63,,41.792,percent of total Billed Charges,63% of total Billed Charges,51.41,62,,41.128,percent of total Billed Charges,62% of total Billed Charges,52.24,63,,41.792,percent of total billed charges,63% of total Billed Charges,51.41,62,,41.128,percent of total Billed Charges,62% of total Billed Charges,66.34,80,,53.072,percent of total Billed Charges,80% of Total Billed Charges,51.41,62,,41.128,percent of total Billed Charges,62% of total Billed Charges,51.41,62,,41.128,percent of total Billed Charges,62% of total Billed Charges,51.41,70.48,
BENEPROTEIN ORAL POWDER PACKET,72351,CDM,270,RC,,,Outpatient,,,28.88,20.216,,23.1,80,,18.48,percent of total Billed Charges,80% of Total Billed Charges,18.19,63,,14.552,percent of total Billed charges,63% of Total Billed Charges,17.91,62,,14.328,percent of total Billed Charges,62% of total BIlled charges,18.19,63,,14.552,percent of total Billed Charges,63% of total Billed Charges,24.55,85,,19.64,percent of total Billed Charges,85% of total Billed Charges,23.1,80,,18.48,percent of total Billed Charges,80% of total Billed Charges,17.91,62,,14.328,percent of total Billed Charges,62% of total Billed Charges,18.19,63,,14.552,percent of total Billed Charges,63% of total Billed Charges,17.91,62,,14.328,percent of total Billed Charges,62% of total Billed Charges,18.19,63,,14.552,percent of total billed charges,63% of total Billed Charges,17.91,62,,14.328,percent of total Billed Charges,62% of total Billed Charges,23.1,80,,18.48,percent of total Billed Charges,80% of Total Billed Charges,17.91,62,,14.328,percent of total Billed Charges,62% of total Billed Charges,17.91,62,,14.328,percent of total Billed Charges,62% of total Billed Charges,17.91,24.55,
BENEPROTEIN ORAL POWDER PACKET,72352,CDM,270,RC,,,Outpatient,,,9.1,6.37,,7.28,80,,5.824,percent of total Billed Charges,80% of Total Billed Charges,5.73,63,,4.584,percent of total Billed charges,63% of Total Billed Charges,5.64,62,,4.512,percent of total Billed Charges,62% of total BIlled charges,5.73,63,,4.584,percent of total Billed Charges,63% of total Billed Charges,7.74,85,,6.192,percent of total Billed Charges,85% of total Billed Charges,7.28,80,,5.824,percent of total Billed Charges,80% of total Billed Charges,5.64,62,,4.512,percent of total Billed Charges,62% of total Billed Charges,5.73,63,,4.584,percent of total Billed Charges,63% of total Billed Charges,5.64,62,,4.512,percent of total Billed Charges,62% of total Billed Charges,5.73,63,,4.584,percent of total billed charges,63% of total Billed Charges,5.64,62,,4.512,percent of total Billed Charges,62% of total Billed Charges,7.28,80,,5.824,percent of total Billed Charges,80% of Total Billed Charges,5.64,62,,4.512,percent of total Billed Charges,62% of total Billed Charges,5.64,62,,4.512,percent of total Billed Charges,62% of total Billed Charges,5.64,7.74,
BENEPROTEIN ORAL POWDER PACKET,72349,CDM,270,RC,,,Outpatient,,,42.14,29.498,,33.71,80,,26.968,percent of total Billed Charges,80% of Total Billed Charges,26.55,63,,21.24,percent of total Billed charges,63% of Total Billed Charges,26.13,62,,20.904,percent of total Billed Charges,62% of total BIlled charges,26.55,63,,21.24,percent of total Billed Charges,63% of total Billed Charges,35.82,85,,28.656,percent of total Billed Charges,85% of total Billed Charges,33.71,80,,26.968,percent of total Billed Charges,80% of total Billed Charges,26.13,62,,20.904,percent of total Billed Charges,62% of total Billed Charges,26.55,63,,21.24,percent of total Billed Charges,63% of total Billed Charges,26.13,62,,20.904,percent of total Billed Charges,62% of total Billed Charges,26.55,63,,21.24,percent of total billed charges,63% of total Billed Charges,26.13,62,,20.904,percent of total Billed Charges,62% of total Billed Charges,33.71,80,,26.968,percent of total Billed Charges,80% of Total Billed Charges,26.13,62,,20.904,percent of total Billed Charges,62% of total Billed Charges,26.13,62,,20.904,percent of total Billed Charges,62% of total Billed Charges,26.13,35.82,
BENEPROTEIN ORAL POWDER PACKET,72350,CDM,270,RC,,,Outpatient,,,59.43,41.601,,47.54,80,,38.032,percent of total Billed Charges,80% of Total Billed Charges,37.44,63,,29.952,percent of total Billed charges,63% of Total Billed Charges,36.85,62,,29.48,percent of total Billed Charges,62% of total BIlled charges,37.44,63,,29.952,percent of total Billed Charges,63% of total Billed Charges,50.52,85,,40.416,percent of total Billed Charges,85% of total Billed Charges,47.54,80,,38.032,percent of total Billed Charges,80% of total Billed Charges,36.85,62,,29.48,percent of total Billed Charges,62% of total Billed Charges,37.44,63,,29.952,percent of total Billed Charges,63% of total Billed Charges,36.85,62,,29.48,percent of total Billed Charges,62% of total Billed Charges,37.44,63,,29.952,percent of total billed charges,63% of total Billed Charges,36.85,62,,29.48,percent of total Billed Charges,62% of total Billed Charges,47.54,80,,38.032,percent of total Billed Charges,80% of Total Billed Charges,36.85,62,,29.48,percent of total Billed Charges,62% of total Billed Charges,36.85,62,,29.48,percent of total Billed Charges,62% of total Billed Charges,36.85,50.52,
BENEPROTEIN ORAL POWDER PACKET,70360,CDM,270,RC,,,Outpatient,,,99.78,69.846,,79.82,80,,63.856,percent of total Billed Charges,80% of Total Billed Charges,62.86,63,,50.288,percent of total Billed charges,63% of Total Billed Charges,61.86,62,,49.488,percent of total Billed Charges,62% of total BIlled charges,62.86,63,,50.288,percent of total Billed Charges,63% of total Billed Charges,84.81,85,,67.848,percent of total Billed Charges,85% of total Billed Charges,79.82,80,,63.856,percent of total Billed Charges,80% of total Billed Charges,61.86,62,,49.488,percent of total Billed Charges,62% of total Billed Charges,62.86,63,,50.288,percent of total Billed Charges,63% of total Billed Charges,61.86,62,,49.488,percent of total Billed Charges,62% of total Billed Charges,62.86,63,,50.288,percent of total billed charges,63% of total Billed Charges,61.86,62,,49.488,percent of total Billed Charges,62% of total Billed Charges,79.82,80,,63.856,percent of total Billed Charges,80% of Total Billed Charges,61.86,62,,49.488,percent of total Billed Charges,62% of total Billed Charges,61.86,62,,49.488,percent of total Billed Charges,62% of total Billed Charges,61.86,84.81,
BENEPROTEIN ORAL POWDER PACKET,72195,CDM,270,RC,,,Outpatient,,,12.39,8.673,,9.91,80,,7.928,percent of total Billed Charges,80% of Total Billed Charges,7.81,63,,6.248,percent of total Billed charges,63% of Total Billed Charges,7.68,62,,6.144,percent of total Billed Charges,62% of total BIlled charges,7.81,63,,6.248,percent of total Billed Charges,63% of total Billed Charges,10.53,85,,8.424,percent of total Billed Charges,85% of total Billed Charges,9.91,80,,7.928,percent of total Billed Charges,80% of total Billed Charges,7.68,62,,6.144,percent of total Billed Charges,62% of total Billed Charges,7.81,63,,6.248,percent of total Billed Charges,63% of total Billed Charges,7.68,62,,6.144,percent of total Billed Charges,62% of total Billed Charges,7.81,63,,6.248,percent of total billed charges,63% of total Billed Charges,7.68,62,,6.144,percent of total Billed Charges,62% of total Billed Charges,9.91,80,,7.928,percent of total Billed Charges,80% of Total Billed Charges,7.68,62,,6.144,percent of total Billed Charges,62% of total Billed Charges,7.68,62,,6.144,percent of total Billed Charges,62% of total Billed Charges,7.68,10.53,
BENEPROTEIN ORAL POWDER PACKET,72234,CDM,270,RC,,,Outpatient,,,10.54,7.378,,8.43,80,,6.744,percent of total Billed Charges,80% of Total Billed Charges,6.64,63,,5.312,percent of total Billed charges,63% of Total Billed Charges,6.53,62,,5.224,percent of total Billed Charges,62% of total BIlled charges,6.64,63,,5.312,percent of total Billed Charges,63% of total Billed Charges,8.96,85,,7.168,percent of total Billed Charges,85% of total Billed Charges,8.43,80,,6.744,percent of total Billed Charges,80% of total Billed Charges,6.53,62,,5.224,percent of total Billed Charges,62% of total Billed Charges,6.64,63,,5.312,percent of total Billed Charges,63% of total Billed Charges,6.53,62,,5.224,percent of total Billed Charges,62% of total Billed Charges,6.64,63,,5.312,percent of total billed charges,63% of total Billed Charges,6.53,62,,5.224,percent of total Billed Charges,62% of total Billed Charges,8.43,80,,6.744,percent of total Billed Charges,80% of Total Billed Charges,6.53,62,,5.224,percent of total Billed Charges,62% of total Billed Charges,6.53,62,,5.224,percent of total Billed Charges,62% of total Billed Charges,6.53,8.96,
BENEPROTEIN ORAL POWDER PACKET,70040,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,150011,CDM,270,RC,,,Outpatient,,,27.41,19.187,,21.93,80,,17.544,percent of total Billed Charges,80% of Total Billed Charges,17.27,63,,13.816,percent of total Billed charges,63% of Total Billed Charges,16.99,62,,13.592,percent of total Billed Charges,62% of total BIlled charges,17.27,63,,13.816,percent of total Billed Charges,63% of total Billed Charges,23.3,85,,18.64,percent of total Billed Charges,85% of total Billed Charges,21.93,80,,17.544,percent of total Billed Charges,80% of total Billed Charges,16.99,62,,13.592,percent of total Billed Charges,62% of total Billed Charges,17.27,63,,13.816,percent of total Billed Charges,63% of total Billed Charges,16.99,62,,13.592,percent of total Billed Charges,62% of total Billed Charges,17.27,63,,13.816,percent of total billed charges,63% of total Billed Charges,16.99,62,,13.592,percent of total Billed Charges,62% of total Billed Charges,21.93,80,,17.544,percent of total Billed Charges,80% of Total Billed Charges,16.99,62,,13.592,percent of total Billed Charges,62% of total Billed Charges,16.99,62,,13.592,percent of total Billed Charges,62% of total Billed Charges,16.99,23.3,
BENEPROTEIN ORAL POWDER PACKET,70530,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70043,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71658,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70557,CDM,270,RC,,,Outpatient,,,606.25,424.375,,485,80,,388,percent of total Billed Charges,80% of Total Billed Charges,381.94,63,,305.552,percent of total Billed charges,63% of Total Billed Charges,375.88,62,,300.704,percent of total Billed Charges,62% of total BIlled charges,381.94,63,,305.552,percent of total Billed Charges,63% of total Billed Charges,515.31,85,,412.248,percent of total Billed Charges,85% of total Billed Charges,485,80,,388,percent of total Billed Charges,80% of total Billed Charges,375.88,62,,300.704,percent of total Billed Charges,62% of total Billed Charges,381.94,63,,305.552,percent of total Billed Charges,63% of total Billed Charges,375.88,62,,300.704,percent of total Billed Charges,62% of total Billed Charges,381.94,63,,305.552,percent of total billed charges,63% of total Billed Charges,375.88,62,,300.704,percent of total Billed Charges,62% of total Billed Charges,485,80,,388,percent of total Billed Charges,80% of Total Billed Charges,375.88,62,,300.704,percent of total Billed Charges,62% of total Billed Charges,375.88,62,,300.704,percent of total Billed Charges,62% of total Billed Charges,375.88,515.31,
BENEPROTEIN ORAL POWDER PACKET,70044,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
ENSURE BPN ARC INST LIQ 24X8 OZ,72275,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
ENSURE BT INST CHOC 24X8OZ,72276,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
ENSURE CHO ARC INST LIQ 24X8 OZ,72277,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
ENSURE CLR APP ARC INST LIQ 24X8 OZ,72278,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
ENSURE CLR MXD BRY ARC INST LIQ 24X8 OZ,72279,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
ENSURE INST STRAWBERRY BOTTLE 24X8OZ,72280,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
ENSURE PLUS CHO ARC INST LIQ 24X8 OZ,72281,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
ENSURE PLUS INST CHOCOLATE BTL 24X8OZ,72282,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
ENSURE PLUS INST STRAWBERY BTL 24X8OZ,72283,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
ENSURE PLUS INST VANILLA BTL 24X8OZ,72284,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
ENSURE PLUS STR ARC INST LIQ 24X8 OZ,72285,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
ENSURE PLUS VAN ARC INST LIQ 24X8 OZ,72286,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
ENSURE PUDDING OLD FASHN VANILA 12X4X4OZ,72267,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
ENSURE STR ARC INST LIQ 24X8 OZ,72287,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
ENSURE VAN ARC INST LIQ 24X8 OZ,72288,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,130019,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,130025,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,130015,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,130021,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,130020,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,130013,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,130022,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,130014,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,130023,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,130024,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,130016,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,130017,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72140,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70788,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,50137,CDM,270,RC,,,Outpatient,,,40.85,28.595,,32.68,80,,26.144,percent of total Billed Charges,80% of Total Billed Charges,25.74,63,,20.592,percent of total Billed charges,63% of Total Billed Charges,25.33,62,,20.264,percent of total Billed Charges,62% of total BIlled charges,25.74,63,,20.592,percent of total Billed Charges,63% of total Billed Charges,34.72,85,,27.776,percent of total Billed Charges,85% of total Billed Charges,32.68,80,,26.144,percent of total Billed Charges,80% of total Billed Charges,25.33,62,,20.264,percent of total Billed Charges,62% of total Billed Charges,25.74,63,,20.592,percent of total Billed Charges,63% of total Billed Charges,25.33,62,,20.264,percent of total Billed Charges,62% of total Billed Charges,25.74,63,,20.592,percent of total billed charges,63% of total Billed Charges,25.33,62,,20.264,percent of total Billed Charges,62% of total Billed Charges,32.68,80,,26.144,percent of total Billed Charges,80% of Total Billed Charges,25.33,62,,20.264,percent of total Billed Charges,62% of total Billed Charges,25.33,62,,20.264,percent of total Billed Charges,62% of total Billed Charges,25.33,34.72,
BENEPROTEIN ORAL POWDER PACKET,150013,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71815,CDM,270,RC,,,Outpatient,,,6.5,4.55,,5.2,80,,4.16,percent of total Billed Charges,80% of Total Billed Charges,4.1,63,,3.28,percent of total Billed charges,63% of Total Billed Charges,4.03,62,,3.224,percent of total Billed Charges,62% of total BIlled charges,4.1,63,,3.28,percent of total Billed Charges,63% of total Billed Charges,5.53,85,,4.424,percent of total Billed Charges,85% of total Billed Charges,5.2,80,,4.16,percent of total Billed Charges,80% of total Billed Charges,4.03,62,,3.224,percent of total Billed Charges,62% of total Billed Charges,4.1,63,,3.28,percent of total Billed Charges,63% of total Billed Charges,4.03,62,,3.224,percent of total Billed Charges,62% of total Billed Charges,4.1,63,,3.28,percent of total billed charges,63% of total Billed Charges,4.03,62,,3.224,percent of total Billed Charges,62% of total Billed Charges,5.2,80,,4.16,percent of total Billed Charges,80% of Total Billed Charges,4.03,62,,3.224,percent of total Billed Charges,62% of total Billed Charges,4.03,62,,3.224,percent of total Billed Charges,62% of total Billed Charges,4.03,5.53,
BENEPROTEIN ORAL POWDER PACKET,72074,CDM,270,RC,,,Outpatient,,,73.36,51.352,,58.69,80,,46.952,percent of total Billed Charges,80% of Total Billed Charges,46.22,63,,36.976,percent of total Billed charges,63% of Total Billed Charges,45.48,62,,36.384,percent of total Billed Charges,62% of total BIlled charges,46.22,63,,36.976,percent of total Billed Charges,63% of total Billed Charges,62.36,85,,49.888,percent of total Billed Charges,85% of total Billed Charges,58.69,80,,46.952,percent of total Billed Charges,80% of total Billed Charges,45.48,62,,36.384,percent of total Billed Charges,62% of total Billed Charges,46.22,63,,36.976,percent of total Billed Charges,63% of total Billed Charges,45.48,62,,36.384,percent of total Billed Charges,62% of total Billed Charges,46.22,63,,36.976,percent of total billed charges,63% of total Billed Charges,45.48,62,,36.384,percent of total Billed Charges,62% of total Billed Charges,58.69,80,,46.952,percent of total Billed Charges,80% of Total Billed Charges,45.48,62,,36.384,percent of total Billed Charges,62% of total Billed Charges,45.48,62,,36.384,percent of total Billed Charges,62% of total Billed Charges,45.48,62.36,
BENEPROTEIN ORAL POWDER PACKET,70007,CDM,270,RC,,,Outpatient,,,16.35,11.445,,13.08,80,,10.464,percent of total Billed Charges,80% of Total Billed Charges,10.3,63,,8.24,percent of total Billed charges,63% of Total Billed Charges,10.14,62,,8.112,percent of total Billed Charges,62% of total BIlled charges,10.3,63,,8.24,percent of total Billed Charges,63% of total Billed Charges,13.9,85,,11.12,percent of total Billed Charges,85% of total Billed Charges,13.08,80,,10.464,percent of total Billed Charges,80% of total Billed Charges,10.14,62,,8.112,percent of total Billed Charges,62% of total Billed Charges,10.3,63,,8.24,percent of total Billed Charges,63% of total Billed Charges,10.14,62,,8.112,percent of total Billed Charges,62% of total Billed Charges,10.3,63,,8.24,percent of total billed charges,63% of total Billed Charges,10.14,62,,8.112,percent of total Billed Charges,62% of total Billed Charges,13.08,80,,10.464,percent of total Billed Charges,80% of Total Billed Charges,10.14,62,,8.112,percent of total Billed Charges,62% of total Billed Charges,10.14,62,,8.112,percent of total Billed Charges,62% of total Billed Charges,10.14,13.9,
BENEPROTEIN ORAL POWDER PACKET,72339,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70101,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71803,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70051,CDM,270,RC,,,Outpatient,,,7.07,4.949,,5.66,80,,4.528,percent of total Billed Charges,80% of Total Billed Charges,4.45,63,,3.56,percent of total Billed charges,63% of Total Billed Charges,4.38,62,,3.504,percent of total Billed Charges,62% of total BIlled charges,4.45,63,,3.56,percent of total Billed Charges,63% of total Billed Charges,6.01,85,,4.808,percent of total Billed Charges,85% of total Billed Charges,5.66,80,,4.528,percent of total Billed Charges,80% of total Billed Charges,4.38,62,,3.504,percent of total Billed Charges,62% of total Billed Charges,4.45,63,,3.56,percent of total Billed Charges,63% of total Billed Charges,4.38,62,,3.504,percent of total Billed Charges,62% of total Billed Charges,4.45,63,,3.56,percent of total billed charges,63% of total Billed Charges,4.38,62,,3.504,percent of total Billed Charges,62% of total Billed Charges,5.66,80,,4.528,percent of total Billed Charges,80% of Total Billed Charges,4.38,62,,3.504,percent of total Billed Charges,62% of total Billed Charges,4.38,62,,3.504,percent of total Billed Charges,62% of total Billed Charges,4.38,6.01,
BENEPROTEIN ORAL POWDER PACKET,70053,CDM,270,RC,,,Outpatient,,,7,4.9,,5.6,80,,4.48,percent of total Billed Charges,80% of Total Billed Charges,4.41,63,,3.528,percent of total Billed charges,63% of Total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total BIlled charges,4.41,63,,3.528,percent of total Billed Charges,63% of total Billed Charges,5.95,85,,4.76,percent of total Billed Charges,85% of total Billed Charges,5.6,80,,4.48,percent of total Billed Charges,80% of total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,4.41,63,,3.528,percent of total Billed Charges,63% of total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,4.41,63,,3.528,percent of total billed charges,63% of total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,5.6,80,,4.48,percent of total Billed Charges,80% of Total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,4.34,5.95,
BENEPROTEIN ORAL POWDER PACKET,70054,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70863,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70864,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70859,CDM,270,RC,,,Outpatient,,,5.5,3.85,,4.4,80,,3.52,percent of total Billed Charges,80% of Total Billed Charges,3.47,63,,2.776,percent of total Billed charges,63% of Total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total BIlled charges,3.47,63,,2.776,percent of total Billed Charges,63% of total Billed Charges,4.68,85,,3.744,percent of total Billed Charges,85% of total Billed Charges,4.4,80,,3.52,percent of total Billed Charges,80% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.47,63,,2.776,percent of total Billed Charges,63% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.47,63,,2.776,percent of total billed charges,63% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,4.4,80,,3.52,percent of total Billed Charges,80% of Total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.41,4.68,
BENEPROTEIN ORAL POWDER PACKET,70860,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70861,CDM,270,RC,,,Outpatient,,,6,4.2,,4.8,80,,3.84,percent of total Billed Charges,80% of Total Billed Charges,3.78,63,,3.024,percent of total Billed charges,63% of Total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total BIlled charges,3.78,63,,3.024,percent of total Billed Charges,63% of total Billed Charges,5.1,85,,4.08,percent of total Billed Charges,85% of total Billed Charges,4.8,80,,3.84,percent of total Billed Charges,80% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.78,63,,3.024,percent of total Billed Charges,63% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.78,63,,3.024,percent of total billed charges,63% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,4.8,80,,3.84,percent of total Billed Charges,80% of Total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.72,5.1,
BENEPROTEIN ORAL POWDER PACKET,70862,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70057,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72039,CDM,270,RC,,,Outpatient,,,7.7,5.39,,6.16,80,,4.928,percent of total Billed Charges,80% of Total Billed Charges,4.85,63,,3.88,percent of total Billed charges,63% of Total Billed Charges,4.77,62,,3.816,percent of total Billed Charges,62% of total BIlled charges,4.85,63,,3.88,percent of total Billed Charges,63% of total Billed Charges,6.55,85,,5.24,percent of total Billed Charges,85% of total Billed Charges,6.16,80,,4.928,percent of total Billed Charges,80% of total Billed Charges,4.77,62,,3.816,percent of total Billed Charges,62% of total Billed Charges,4.85,63,,3.88,percent of total Billed Charges,63% of total Billed Charges,4.77,62,,3.816,percent of total Billed Charges,62% of total Billed Charges,4.85,63,,3.88,percent of total billed charges,63% of total Billed Charges,4.77,62,,3.816,percent of total Billed Charges,62% of total Billed Charges,6.16,80,,4.928,percent of total Billed Charges,80% of Total Billed Charges,4.77,62,,3.816,percent of total Billed Charges,62% of total Billed Charges,4.77,62,,3.816,percent of total Billed Charges,62% of total Billed Charges,4.77,6.55,
BENEPROTEIN ORAL POWDER PACKET,70887,CDM,270,RC,,,Outpatient,,,83.93,58.751,,67.14,80,,53.712,percent of total Billed Charges,80% of Total Billed Charges,52.88,63,,42.304,percent of total Billed charges,63% of Total Billed Charges,52.04,62,,41.632,percent of total Billed Charges,62% of total BIlled charges,52.88,63,,42.304,percent of total Billed Charges,63% of total Billed Charges,71.34,85,,57.072,percent of total Billed Charges,85% of total Billed Charges,67.14,80,,53.712,percent of total Billed Charges,80% of total Billed Charges,52.04,62,,41.632,percent of total Billed Charges,62% of total Billed Charges,52.88,63,,42.304,percent of total Billed Charges,63% of total Billed Charges,52.04,62,,41.632,percent of total Billed Charges,62% of total Billed Charges,52.88,63,,42.304,percent of total billed charges,63% of total Billed Charges,52.04,62,,41.632,percent of total Billed Charges,62% of total Billed Charges,67.14,80,,53.712,percent of total Billed Charges,80% of Total Billed Charges,52.04,62,,41.632,percent of total Billed Charges,62% of total Billed Charges,52.04,62,,41.632,percent of total Billed Charges,62% of total Billed Charges,52.04,71.34,
BENEPROTEIN ORAL POWDER PACKET,70888,CDM,270,RC,,,Outpatient,,,80.71,56.497,,64.57,80,,51.656,percent of total Billed Charges,80% of Total Billed Charges,50.85,63,,40.68,percent of total Billed charges,63% of Total Billed Charges,50.04,62,,40.032,percent of total Billed Charges,62% of total BIlled charges,50.85,63,,40.68,percent of total Billed Charges,63% of total Billed Charges,68.6,85,,54.88,percent of total Billed Charges,85% of total Billed Charges,64.57,80,,51.656,percent of total Billed Charges,80% of total Billed Charges,50.04,62,,40.032,percent of total Billed Charges,62% of total Billed Charges,50.85,63,,40.68,percent of total Billed Charges,63% of total Billed Charges,50.04,62,,40.032,percent of total Billed Charges,62% of total Billed Charges,50.85,63,,40.68,percent of total billed charges,63% of total Billed Charges,50.04,62,,40.032,percent of total Billed Charges,62% of total Billed Charges,64.57,80,,51.656,percent of total Billed Charges,80% of Total Billed Charges,50.04,62,,40.032,percent of total Billed Charges,62% of total Billed Charges,50.04,62,,40.032,percent of total Billed Charges,62% of total Billed Charges,50.04,68.6,
BENEPROTEIN ORAL POWDER PACKET,70889,CDM,270,RC,,,Outpatient,,,86.91,60.837,,69.53,80,,55.624,percent of total Billed Charges,80% of Total Billed Charges,54.75,63,,43.8,percent of total Billed charges,63% of Total Billed Charges,53.88,62,,43.104,percent of total Billed Charges,62% of total BIlled charges,54.75,63,,43.8,percent of total Billed Charges,63% of total Billed Charges,73.87,85,,59.096,percent of total Billed Charges,85% of total Billed Charges,69.53,80,,55.624,percent of total Billed Charges,80% of total Billed Charges,53.88,62,,43.104,percent of total Billed Charges,62% of total Billed Charges,54.75,63,,43.8,percent of total Billed Charges,63% of total Billed Charges,53.88,62,,43.104,percent of total Billed Charges,62% of total Billed Charges,54.75,63,,43.8,percent of total billed charges,63% of total Billed Charges,53.88,62,,43.104,percent of total Billed Charges,62% of total Billed Charges,69.53,80,,55.624,percent of total Billed Charges,80% of Total Billed Charges,53.88,62,,43.104,percent of total Billed Charges,62% of total Billed Charges,53.88,62,,43.104,percent of total Billed Charges,62% of total Billed Charges,53.88,73.87,
BENEPROTEIN ORAL POWDER PACKET,70886,CDM,270,RC,,,Outpatient,,,115,80.5,,92,80,,73.6,percent of total Billed Charges,80% of Total Billed Charges,72.45,63,,57.96,percent of total Billed charges,63% of Total Billed Charges,71.3,62,,57.04,percent of total Billed Charges,62% of total BIlled charges,72.45,63,,57.96,percent of total Billed Charges,63% of total Billed Charges,97.75,85,,78.2,percent of total Billed Charges,85% of total Billed Charges,92,80,,73.6,percent of total Billed Charges,80% of total Billed Charges,71.3,62,,57.04,percent of total Billed Charges,62% of total Billed Charges,72.45,63,,57.96,percent of total Billed Charges,63% of total Billed Charges,71.3,62,,57.04,percent of total Billed Charges,62% of total Billed Charges,72.45,63,,57.96,percent of total billed charges,63% of total Billed Charges,71.3,62,,57.04,percent of total Billed Charges,62% of total Billed Charges,92,80,,73.6,percent of total Billed Charges,80% of Total Billed Charges,71.3,62,,57.04,percent of total Billed Charges,62% of total Billed Charges,71.3,62,,57.04,percent of total Billed Charges,62% of total Billed Charges,71.3,97.75,
BENEPROTEIN ORAL POWDER PACKET,72317,CDM,270,RC,,,Outpatient,,,127.14,88.998,,101.71,80,,81.368,percent of total Billed Charges,80% of Total Billed Charges,80.1,63,,64.08,percent of total Billed charges,63% of Total Billed Charges,78.83,62,,63.064,percent of total Billed Charges,62% of total BIlled charges,80.1,63,,64.08,percent of total Billed Charges,63% of total Billed Charges,108.07,85,,86.456,percent of total Billed Charges,85% of total Billed Charges,101.71,80,,81.368,percent of total Billed Charges,80% of total Billed Charges,78.83,62,,63.064,percent of total Billed Charges,62% of total Billed Charges,80.1,63,,64.08,percent of total Billed Charges,63% of total Billed Charges,78.83,62,,63.064,percent of total Billed Charges,62% of total Billed Charges,80.1,63,,64.08,percent of total billed charges,63% of total Billed Charges,78.83,62,,63.064,percent of total Billed Charges,62% of total Billed Charges,101.71,80,,81.368,percent of total Billed Charges,80% of Total Billed Charges,78.83,62,,63.064,percent of total Billed Charges,62% of total Billed Charges,78.83,62,,63.064,percent of total Billed Charges,62% of total Billed Charges,78.83,108.07,
BENEPROTEIN ORAL POWDER PACKET,70494,CDM,270,RC,,,Outpatient,,,34.9,24.43,,27.92,80,,22.336,percent of total Billed Charges,80% of Total Billed Charges,21.99,63,,17.592,percent of total Billed charges,63% of Total Billed Charges,21.64,62,,17.312,percent of total Billed Charges,62% of total BIlled charges,21.99,63,,17.592,percent of total Billed Charges,63% of total Billed Charges,29.67,85,,23.736,percent of total Billed Charges,85% of total Billed Charges,27.92,80,,22.336,percent of total Billed Charges,80% of total Billed Charges,21.64,62,,17.312,percent of total Billed Charges,62% of total Billed Charges,21.99,63,,17.592,percent of total Billed Charges,63% of total Billed Charges,21.64,62,,17.312,percent of total Billed Charges,62% of total Billed Charges,21.99,63,,17.592,percent of total billed charges,63% of total Billed Charges,21.64,62,,17.312,percent of total Billed Charges,62% of total Billed Charges,27.92,80,,22.336,percent of total Billed Charges,80% of Total Billed Charges,21.64,62,,17.312,percent of total Billed Charges,62% of total Billed Charges,21.64,62,,17.312,percent of total Billed Charges,62% of total Billed Charges,21.64,29.67,
GLUCERNA 1.0 CAL ARC INST LIQ 24X8 OZ,72291,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
GLUCERNA 1.2C RTH SAF SCRW LIQ 6X1500ML,72292,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
GLUCERNA 1.2CAL 8OZ ARC INST LIQ 24X8 OZ,72293,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
GLUCERNA 1.5 CAL VANILLA 33.8OZ,72365,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
GLUCERNA 1.5 CAL VANILLA INSTITUT 24X8OZ,72294,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
GLUCERNA SHK CHO ARC INST LIQ 24X8 OZ,72295,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
GLUCERNA SHK VAN ARC INST LIQ 24X8 OZ,72296,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,50039,CDM,270,RC,,,Outpatient,,,9.28,6.496,,7.42,80,,5.936,percent of total Billed Charges,80% of Total Billed Charges,5.85,63,,4.68,percent of total Billed charges,63% of Total Billed Charges,5.75,62,,4.6,percent of total Billed Charges,62% of total BIlled charges,5.85,63,,4.68,percent of total Billed Charges,63% of total Billed Charges,7.89,85,,6.312,percent of total Billed Charges,85% of total Billed Charges,7.42,80,,5.936,percent of total Billed Charges,80% of total Billed Charges,5.75,62,,4.6,percent of total Billed Charges,62% of total Billed Charges,5.85,63,,4.68,percent of total Billed Charges,63% of total Billed Charges,5.75,62,,4.6,percent of total Billed Charges,62% of total Billed Charges,5.85,63,,4.68,percent of total billed charges,63% of total Billed Charges,5.75,62,,4.6,percent of total Billed Charges,62% of total Billed Charges,7.42,80,,5.936,percent of total Billed Charges,80% of Total Billed Charges,5.75,62,,4.6,percent of total Billed Charges,62% of total Billed Charges,5.75,62,,4.6,percent of total Billed Charges,62% of total Billed Charges,5.75,7.89,
BENEPROTEIN ORAL POWDER PACKET,72259,CDM,270,RC,,,Outpatient,,,33.29,23.303,,26.63,80,,21.304,percent of total Billed Charges,80% of Total Billed Charges,20.97,63,,16.776,percent of total Billed charges,63% of Total Billed Charges,20.64,62,,16.512,percent of total Billed Charges,62% of total BIlled charges,20.97,63,,16.776,percent of total Billed Charges,63% of total Billed Charges,28.3,85,,22.64,percent of total Billed Charges,85% of total Billed Charges,26.63,80,,21.304,percent of total Billed Charges,80% of total Billed Charges,20.64,62,,16.512,percent of total Billed Charges,62% of total Billed Charges,20.97,63,,16.776,percent of total Billed Charges,63% of total Billed Charges,20.64,62,,16.512,percent of total Billed Charges,62% of total Billed Charges,20.97,63,,16.776,percent of total billed charges,63% of total Billed Charges,20.64,62,,16.512,percent of total Billed Charges,62% of total Billed Charges,26.63,80,,21.304,percent of total Billed Charges,80% of Total Billed Charges,20.64,62,,16.512,percent of total Billed Charges,62% of total Billed Charges,20.64,62,,16.512,percent of total Billed Charges,62% of total Billed Charges,20.64,28.3,
BENEPROTEIN ORAL POWDER PACKET,50040,CDM,270,RC,,,Outpatient,,,7.88,5.516,,6.3,80,,5.04,percent of total Billed Charges,80% of Total Billed Charges,4.96,63,,3.968,percent of total Billed charges,63% of Total Billed Charges,4.89,62,,3.912,percent of total Billed Charges,62% of total BIlled charges,4.96,63,,3.968,percent of total Billed Charges,63% of total Billed Charges,6.7,85,,5.36,percent of total Billed Charges,85% of total Billed Charges,6.3,80,,5.04,percent of total Billed Charges,80% of total Billed Charges,4.89,62,,3.912,percent of total Billed Charges,62% of total Billed Charges,4.96,63,,3.968,percent of total Billed Charges,63% of total Billed Charges,4.89,62,,3.912,percent of total Billed Charges,62% of total Billed Charges,4.96,63,,3.968,percent of total billed charges,63% of total Billed Charges,4.89,62,,3.912,percent of total Billed Charges,62% of total Billed Charges,6.3,80,,5.04,percent of total Billed Charges,80% of Total Billed Charges,4.89,62,,3.912,percent of total Billed Charges,62% of total Billed Charges,4.89,62,,3.912,percent of total Billed Charges,62% of total Billed Charges,4.89,6.7,
BENEPROTEIN ORAL POWDER PACKET,72206,CDM,270,RC,,,Outpatient,,,285,199.5,,228,80,,182.4,percent of total Billed Charges,80% of Total Billed Charges,179.55,63,,143.64,percent of total Billed charges,63% of Total Billed Charges,176.7,62,,141.36,percent of total Billed Charges,62% of total BIlled charges,179.55,63,,143.64,percent of total Billed Charges,63% of total Billed Charges,242.25,85,,193.8,percent of total Billed Charges,85% of total Billed Charges,228,80,,182.4,percent of total Billed Charges,80% of total Billed Charges,176.7,62,,141.36,percent of total Billed Charges,62% of total Billed Charges,179.55,63,,143.64,percent of total Billed Charges,63% of total Billed Charges,176.7,62,,141.36,percent of total Billed Charges,62% of total Billed Charges,179.55,63,,143.64,percent of total billed charges,63% of total Billed Charges,176.7,62,,141.36,percent of total Billed Charges,62% of total Billed Charges,228,80,,182.4,percent of total Billed Charges,80% of Total Billed Charges,176.7,62,,141.36,percent of total Billed Charges,62% of total Billed Charges,176.7,62,,141.36,percent of total Billed Charges,62% of total Billed Charges,176.7,242.25,
BENEPROTEIN ORAL POWDER PACKET,CDM,CDM,270,RC,,,Outpatient,,,202.38,141.666,,161.9,80,,129.52,percent of total Billed Charges,80% of Total Billed Charges,127.5,63,,102,percent of total Billed charges,63% of Total Billed Charges,125.48,62,,100.384,percent of total Billed Charges,62% of total BIlled charges,127.5,63,,102,percent of total Billed Charges,63% of total Billed Charges,172.02,85,,137.616,percent of total Billed Charges,85% of total Billed Charges,161.9,80,,129.52,percent of total Billed Charges,80% of total Billed Charges,125.48,62,,100.384,percent of total Billed Charges,62% of total Billed Charges,127.5,63,,102,percent of total Billed Charges,63% of total Billed Charges,125.48,62,,100.384,percent of total Billed Charges,62% of total Billed Charges,127.5,63,,102,percent of total billed charges,63% of total Billed Charges,125.48,62,,100.384,percent of total Billed Charges,62% of total Billed Charges,161.9,80,,129.52,percent of total Billed Charges,80% of Total Billed Charges,125.48,62,,100.384,percent of total Billed Charges,62% of total Billed Charges,125.48,62,,100.384,percent of total Billed Charges,62% of total Billed Charges,125.48,172.02,
BENEPROTEIN ORAL POWDER PACKET,72205,CDM,270,RC,,,Outpatient,,,77,53.9,,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,48.51,63,,38.808,percent of total Billed charges,63% of Total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total BIlled charges,48.51,63,,38.808,percent of total Billed Charges,63% of total Billed Charges,65.45,85,,52.36,percent of total Billed Charges,85% of total Billed Charges,61.6,80,,49.28,percent of total Billed Charges,80% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,48.51,63,,38.808,percent of total Billed Charges,63% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,48.51,63,,38.808,percent of total billed charges,63% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,47.74,65.45,
BENEPROTEIN ORAL POWDER PACKET,70058,CDM,270,RC,,,Outpatient,,,12.88,9.016,,10.3,80,,8.24,percent of total Billed Charges,80% of Total Billed Charges,8.11,63,,6.488,percent of total Billed charges,63% of Total Billed Charges,7.99,62,,6.392,percent of total Billed Charges,62% of total BIlled charges,8.11,63,,6.488,percent of total Billed Charges,63% of total Billed Charges,10.95,85,,8.76,percent of total Billed Charges,85% of total Billed Charges,10.3,80,,8.24,percent of total Billed Charges,80% of total Billed Charges,7.99,62,,6.392,percent of total Billed Charges,62% of total Billed Charges,8.11,63,,6.488,percent of total Billed Charges,63% of total Billed Charges,7.99,62,,6.392,percent of total Billed Charges,62% of total Billed Charges,8.11,63,,6.488,percent of total billed charges,63% of total Billed Charges,7.99,62,,6.392,percent of total Billed Charges,62% of total Billed Charges,10.3,80,,8.24,percent of total Billed Charges,80% of Total Billed Charges,7.99,62,,6.392,percent of total Billed Charges,62% of total Billed Charges,7.99,62,,6.392,percent of total Billed Charges,62% of total Billed Charges,7.99,10.95,
BENEPROTEIN ORAL POWDER PACKET,72260,CDM,270,RC,,,Outpatient,,,169.47,118.629,,135.58,80,,108.464,percent of total Billed Charges,80% of Total Billed Charges,106.77,63,,85.416,percent of total Billed charges,63% of Total Billed Charges,105.07,62,,84.056,percent of total Billed Charges,62% of total BIlled charges,106.77,63,,85.416,percent of total Billed Charges,63% of total Billed Charges,144.05,85,,115.24,percent of total Billed Charges,85% of total Billed Charges,135.58,80,,108.464,percent of total Billed Charges,80% of total Billed Charges,105.07,62,,84.056,percent of total Billed Charges,62% of total Billed Charges,106.77,63,,85.416,percent of total Billed Charges,63% of total Billed Charges,105.07,62,,84.056,percent of total Billed Charges,62% of total Billed Charges,106.77,63,,85.416,percent of total billed charges,63% of total Billed Charges,105.07,62,,84.056,percent of total Billed Charges,62% of total Billed Charges,135.58,80,,108.464,percent of total Billed Charges,80% of Total Billed Charges,105.07,62,,84.056,percent of total Billed Charges,62% of total Billed Charges,105.07,62,,84.056,percent of total Billed Charges,62% of total Billed Charges,105.07,144.05,
BENEPROTEIN ORAL POWDER PACKET,72095,CDM,270,RC,,,Outpatient,,,29.61,20.727,,23.69,80,,18.952,percent of total Billed Charges,80% of Total Billed Charges,18.65,63,,14.92,percent of total Billed charges,63% of Total Billed Charges,18.36,62,,14.688,percent of total Billed Charges,62% of total BIlled charges,18.65,63,,14.92,percent of total Billed Charges,63% of total Billed Charges,25.17,85,,20.136,percent of total Billed Charges,85% of total Billed Charges,23.69,80,,18.952,percent of total Billed Charges,80% of total Billed Charges,18.36,62,,14.688,percent of total Billed Charges,62% of total Billed Charges,18.65,63,,14.92,percent of total Billed Charges,63% of total Billed Charges,18.36,62,,14.688,percent of total Billed Charges,62% of total Billed Charges,18.65,63,,14.92,percent of total billed charges,63% of total Billed Charges,18.36,62,,14.688,percent of total Billed Charges,62% of total Billed Charges,23.69,80,,18.952,percent of total Billed Charges,80% of Total Billed Charges,18.36,62,,14.688,percent of total Billed Charges,62% of total Billed Charges,18.36,62,,14.688,percent of total Billed Charges,62% of total Billed Charges,18.36,25.17,
BENEPROTEIN ORAL POWDER PACKET,72038,CDM,270,RC,,,Outpatient,,,30.5,21.35,,24.4,80,,19.52,percent of total Billed Charges,80% of Total Billed Charges,19.22,63,,15.376,percent of total Billed charges,63% of Total Billed Charges,18.91,62,,15.128,percent of total Billed Charges,62% of total BIlled charges,19.22,63,,15.376,percent of total Billed Charges,63% of total Billed Charges,25.93,85,,20.744,percent of total Billed Charges,85% of total Billed Charges,24.4,80,,19.52,percent of total Billed Charges,80% of total Billed Charges,18.91,62,,15.128,percent of total Billed Charges,62% of total Billed Charges,19.22,63,,15.376,percent of total Billed Charges,63% of total Billed Charges,18.91,62,,15.128,percent of total Billed Charges,62% of total Billed Charges,19.22,63,,15.376,percent of total billed charges,63% of total Billed Charges,18.91,62,,15.128,percent of total Billed Charges,62% of total Billed Charges,24.4,80,,19.52,percent of total Billed Charges,80% of Total Billed Charges,18.91,62,,15.128,percent of total Billed Charges,62% of total Billed Charges,18.91,62,,15.128,percent of total Billed Charges,62% of total Billed Charges,18.91,25.93,
BENEPROTEIN ORAL POWDER PACKET,72318,CDM,270,RC,,,Outpatient,,,37.66,26.362,,30.13,80,,24.104,percent of total Billed Charges,80% of Total Billed Charges,23.73,63,,18.984,percent of total Billed charges,63% of Total Billed Charges,23.35,62,,18.68,percent of total Billed Charges,62% of total BIlled charges,23.73,63,,18.984,percent of total Billed Charges,63% of total Billed Charges,32.01,85,,25.608,percent of total Billed Charges,85% of total Billed Charges,30.13,80,,24.104,percent of total Billed Charges,80% of total Billed Charges,23.35,62,,18.68,percent of total Billed Charges,62% of total Billed Charges,23.73,63,,18.984,percent of total Billed Charges,63% of total Billed Charges,23.35,62,,18.68,percent of total Billed Charges,62% of total Billed Charges,23.73,63,,18.984,percent of total billed charges,63% of total Billed Charges,23.35,62,,18.68,percent of total Billed Charges,62% of total Billed Charges,30.13,80,,24.104,percent of total Billed Charges,80% of Total Billed Charges,23.35,62,,18.68,percent of total Billed Charges,62% of total Billed Charges,23.35,62,,18.68,percent of total Billed Charges,62% of total Billed Charges,23.35,32.01,
BENEPROTEIN ORAL POWDER PACKET,72106,CDM,270,RC,,,Outpatient,,,5.32,3.724,,4.26,80,,3.408,percent of total Billed Charges,80% of Total Billed Charges,3.35,63,,2.68,percent of total Billed charges,63% of Total Billed Charges,3.3,62,,2.64,percent of total Billed Charges,62% of total BIlled charges,3.35,63,,2.68,percent of total Billed Charges,63% of total Billed Charges,4.52,85,,3.616,percent of total Billed Charges,85% of total Billed Charges,4.26,80,,3.408,percent of total Billed Charges,80% of total Billed Charges,3.3,62,,2.64,percent of total Billed Charges,62% of total Billed Charges,3.35,63,,2.68,percent of total Billed Charges,63% of total Billed Charges,3.3,62,,2.64,percent of total Billed Charges,62% of total Billed Charges,3.35,63,,2.68,percent of total billed charges,63% of total Billed Charges,3.3,62,,2.64,percent of total Billed Charges,62% of total Billed Charges,4.26,80,,3.408,percent of total Billed Charges,80% of Total Billed Charges,3.3,62,,2.64,percent of total Billed Charges,62% of total Billed Charges,3.3,62,,2.64,percent of total Billed Charges,62% of total Billed Charges,3.3,4.52,
BENEPROTEIN ORAL POWDER PACKET,72111,CDM,270,RC,,,Outpatient,,,15,10.5,,12,80,,9.6,percent of total Billed Charges,80% of Total Billed Charges,9.45,63,,7.56,percent of total Billed charges,63% of Total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total BIlled charges,9.45,63,,7.56,percent of total Billed Charges,63% of total Billed Charges,12.75,85,,10.2,percent of total Billed Charges,85% of total Billed Charges,12,80,,9.6,percent of total Billed Charges,80% of total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total Billed Charges,9.45,63,,7.56,percent of total Billed Charges,63% of total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total Billed Charges,9.45,63,,7.56,percent of total billed charges,63% of total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total Billed Charges,12,80,,9.6,percent of total Billed Charges,80% of Total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total Billed Charges,9.3,12.75,
BENEPROTEIN ORAL POWDER PACKET,70755,CDM,270,RC,,,Outpatient,,,9,6.3,,7.2,80,,5.76,percent of total Billed Charges,80% of Total Billed Charges,5.67,63,,4.536,percent of total Billed charges,63% of Total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total BIlled charges,5.67,63,,4.536,percent of total Billed Charges,63% of total Billed Charges,7.65,85,,6.12,percent of total Billed Charges,85% of total Billed Charges,7.2,80,,5.76,percent of total Billed Charges,80% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.67,63,,4.536,percent of total Billed Charges,63% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.67,63,,4.536,percent of total billed charges,63% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,7.2,80,,5.76,percent of total Billed Charges,80% of Total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.58,7.65,
BENEPROTEIN ORAL POWDER PACKET,70063,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72132,CDM,270,RC,,,Outpatient,,,7.07,4.949,,5.66,80,,4.528,percent of total Billed Charges,80% of Total Billed Charges,4.45,63,,3.56,percent of total Billed charges,63% of Total Billed Charges,4.38,62,,3.504,percent of total Billed Charges,62% of total BIlled charges,4.45,63,,3.56,percent of total Billed Charges,63% of total Billed Charges,6.01,85,,4.808,percent of total Billed Charges,85% of total Billed Charges,5.66,80,,4.528,percent of total Billed Charges,80% of total Billed Charges,4.38,62,,3.504,percent of total Billed Charges,62% of total Billed Charges,4.45,63,,3.56,percent of total Billed Charges,63% of total Billed Charges,4.38,62,,3.504,percent of total Billed Charges,62% of total Billed Charges,4.45,63,,3.56,percent of total billed charges,63% of total Billed Charges,4.38,62,,3.504,percent of total Billed Charges,62% of total Billed Charges,5.66,80,,4.528,percent of total Billed Charges,80% of Total Billed Charges,4.38,62,,3.504,percent of total Billed Charges,62% of total Billed Charges,4.38,62,,3.504,percent of total Billed Charges,62% of total Billed Charges,4.38,6.01,
BENEPROTEIN ORAL POWDER PACKET,72161,CDM,270,RC,,,Outpatient,,,74.94,52.458,,59.95,80,,47.96,percent of total Billed Charges,80% of Total Billed Charges,47.21,63,,37.768,percent of total Billed charges,63% of Total Billed Charges,46.46,62,,37.168,percent of total Billed Charges,62% of total BIlled charges,47.21,63,,37.768,percent of total Billed Charges,63% of total Billed Charges,63.7,85,,50.96,percent of total Billed Charges,85% of total Billed Charges,59.95,80,,47.96,percent of total Billed Charges,80% of total Billed Charges,46.46,62,,37.168,percent of total Billed Charges,62% of total Billed Charges,47.21,63,,37.768,percent of total Billed Charges,63% of total Billed Charges,46.46,62,,37.168,percent of total Billed Charges,62% of total Billed Charges,47.21,63,,37.768,percent of total billed charges,63% of total Billed Charges,46.46,62,,37.168,percent of total Billed Charges,62% of total Billed Charges,59.95,80,,47.96,percent of total Billed Charges,80% of Total Billed Charges,46.46,62,,37.168,percent of total Billed Charges,62% of total Billed Charges,46.46,62,,37.168,percent of total Billed Charges,62% of total Billed Charges,46.46,63.7,
BENEPROTEIN ORAL POWDER PACKET,72162,CDM,270,RC,,,Outpatient,,,60.48,42.336,,48.38,80,,38.704,percent of total Billed Charges,80% of Total Billed Charges,38.1,63,,30.48,percent of total Billed charges,63% of Total Billed Charges,37.5,62,,30,percent of total Billed Charges,62% of total BIlled charges,38.1,63,,30.48,percent of total Billed Charges,63% of total Billed Charges,51.41,85,,41.128,percent of total Billed Charges,85% of total Billed Charges,48.38,80,,38.704,percent of total Billed Charges,80% of total Billed Charges,37.5,62,,30,percent of total Billed Charges,62% of total Billed Charges,38.1,63,,30.48,percent of total Billed Charges,63% of total Billed Charges,37.5,62,,30,percent of total Billed Charges,62% of total Billed Charges,38.1,63,,30.48,percent of total billed charges,63% of total Billed Charges,37.5,62,,30,percent of total Billed Charges,62% of total Billed Charges,48.38,80,,38.704,percent of total Billed Charges,80% of Total Billed Charges,37.5,62,,30,percent of total Billed Charges,62% of total Billed Charges,37.5,62,,30,percent of total Billed Charges,62% of total Billed Charges,37.5,51.41,
BENEPROTEIN ORAL POWDER PACKET,72163,CDM,270,RC,,,Outpatient,,,60.48,42.336,,48.38,80,,38.704,percent of total Billed Charges,80% of Total Billed Charges,38.1,63,,30.48,percent of total Billed charges,63% of Total Billed Charges,37.5,62,,30,percent of total Billed Charges,62% of total BIlled charges,38.1,63,,30.48,percent of total Billed Charges,63% of total Billed Charges,51.41,85,,41.128,percent of total Billed Charges,85% of total Billed Charges,48.38,80,,38.704,percent of total Billed Charges,80% of total Billed Charges,37.5,62,,30,percent of total Billed Charges,62% of total Billed Charges,38.1,63,,30.48,percent of total Billed Charges,63% of total Billed Charges,37.5,62,,30,percent of total Billed Charges,62% of total Billed Charges,38.1,63,,30.48,percent of total billed charges,63% of total Billed Charges,37.5,62,,30,percent of total Billed Charges,62% of total Billed Charges,48.38,80,,38.704,percent of total Billed Charges,80% of Total Billed Charges,37.5,62,,30,percent of total Billed Charges,62% of total Billed Charges,37.5,62,,30,percent of total Billed Charges,62% of total Billed Charges,37.5,51.41,
BENEPROTEIN ORAL POWDER PACKET,72097,CDM,270,RC,,,Outpatient,,,31.33,21.931,,25.06,80,,20.048,percent of total Billed Charges,80% of Total Billed Charges,19.74,63,,15.792,percent of total Billed charges,63% of Total Billed Charges,19.42,62,,15.536,percent of total Billed Charges,62% of total BIlled charges,19.74,63,,15.792,percent of total Billed Charges,63% of total Billed Charges,26.63,85,,21.304,percent of total Billed Charges,85% of total Billed Charges,25.06,80,,20.048,percent of total Billed Charges,80% of total Billed Charges,19.42,62,,15.536,percent of total Billed Charges,62% of total Billed Charges,19.74,63,,15.792,percent of total Billed Charges,63% of total Billed Charges,19.42,62,,15.536,percent of total Billed Charges,62% of total Billed Charges,19.74,63,,15.792,percent of total billed charges,63% of total Billed Charges,19.42,62,,15.536,percent of total Billed Charges,62% of total Billed Charges,25.06,80,,20.048,percent of total Billed Charges,80% of Total Billed Charges,19.42,62,,15.536,percent of total Billed Charges,62% of total Billed Charges,19.42,62,,15.536,percent of total Billed Charges,62% of total Billed Charges,19.42,26.63,
BENEPROTEIN ORAL POWDER PACKET,72102,CDM,270,RC,,,Outpatient,,,45,31.5,,36,80,,28.8,percent of total Billed Charges,80% of Total Billed Charges,28.35,63,,22.68,percent of total Billed charges,63% of Total Billed Charges,27.9,62,,22.32,percent of total Billed Charges,62% of total BIlled charges,28.35,63,,22.68,percent of total Billed Charges,63% of total Billed Charges,38.25,85,,30.6,percent of total Billed Charges,85% of total Billed Charges,36,80,,28.8,percent of total Billed Charges,80% of total Billed Charges,27.9,62,,22.32,percent of total Billed Charges,62% of total Billed Charges,28.35,63,,22.68,percent of total Billed Charges,63% of total Billed Charges,27.9,62,,22.32,percent of total Billed Charges,62% of total Billed Charges,28.35,63,,22.68,percent of total billed charges,63% of total Billed Charges,27.9,62,,22.32,percent of total Billed Charges,62% of total Billed Charges,36,80,,28.8,percent of total Billed Charges,80% of Total Billed Charges,27.9,62,,22.32,percent of total Billed Charges,62% of total Billed Charges,27.9,62,,22.32,percent of total Billed Charges,62% of total Billed Charges,27.9,38.25,
BENEPROTEIN ORAL POWDER PACKET,72098,CDM,270,RC,,,Outpatient,,,45,31.5,,36,80,,28.8,percent of total Billed Charges,80% of Total Billed Charges,28.35,63,,22.68,percent of total Billed charges,63% of Total Billed Charges,27.9,62,,22.32,percent of total Billed Charges,62% of total BIlled charges,28.35,63,,22.68,percent of total Billed Charges,63% of total Billed Charges,38.25,85,,30.6,percent of total Billed Charges,85% of total Billed Charges,36,80,,28.8,percent of total Billed Charges,80% of total Billed Charges,27.9,62,,22.32,percent of total Billed Charges,62% of total Billed Charges,28.35,63,,22.68,percent of total Billed Charges,63% of total Billed Charges,27.9,62,,22.32,percent of total Billed Charges,62% of total Billed Charges,28.35,63,,22.68,percent of total billed charges,63% of total Billed Charges,27.9,62,,22.32,percent of total Billed Charges,62% of total Billed Charges,36,80,,28.8,percent of total Billed Charges,80% of Total Billed Charges,27.9,62,,22.32,percent of total Billed Charges,62% of total Billed Charges,27.9,62,,22.32,percent of total Billed Charges,62% of total Billed Charges,27.9,38.25,
BENEPROTEIN ORAL POWDER PACKET,72103,CDM,270,RC,,,Outpatient,,,45,31.5,,36,80,,28.8,percent of total Billed Charges,80% of Total Billed Charges,28.35,63,,22.68,percent of total Billed charges,63% of Total Billed Charges,27.9,62,,22.32,percent of total Billed Charges,62% of total BIlled charges,28.35,63,,22.68,percent of total Billed Charges,63% of total Billed Charges,38.25,85,,30.6,percent of total Billed Charges,85% of total Billed Charges,36,80,,28.8,percent of total Billed Charges,80% of total Billed Charges,27.9,62,,22.32,percent of total Billed Charges,62% of total Billed Charges,28.35,63,,22.68,percent of total Billed Charges,63% of total Billed Charges,27.9,62,,22.32,percent of total Billed Charges,62% of total Billed Charges,28.35,63,,22.68,percent of total billed charges,63% of total Billed Charges,27.9,62,,22.32,percent of total Billed Charges,62% of total Billed Charges,36,80,,28.8,percent of total Billed Charges,80% of Total Billed Charges,27.9,62,,22.32,percent of total Billed Charges,62% of total Billed Charges,27.9,62,,22.32,percent of total Billed Charges,62% of total Billed Charges,27.9,38.25,
BENEPROTEIN ORAL POWDER PACKET,72099,CDM,270,RC,,,Outpatient,,,31.33,21.931,,25.06,80,,20.048,percent of total Billed Charges,80% of Total Billed Charges,19.74,63,,15.792,percent of total Billed charges,63% of Total Billed Charges,19.42,62,,15.536,percent of total Billed Charges,62% of total BIlled charges,19.74,63,,15.792,percent of total Billed Charges,63% of total Billed Charges,26.63,85,,21.304,percent of total Billed Charges,85% of total Billed Charges,25.06,80,,20.048,percent of total Billed Charges,80% of total Billed Charges,19.42,62,,15.536,percent of total Billed Charges,62% of total Billed Charges,19.74,63,,15.792,percent of total Billed Charges,63% of total Billed Charges,19.42,62,,15.536,percent of total Billed Charges,62% of total Billed Charges,19.74,63,,15.792,percent of total billed charges,63% of total Billed Charges,19.42,62,,15.536,percent of total Billed Charges,62% of total Billed Charges,25.06,80,,20.048,percent of total Billed Charges,80% of Total Billed Charges,19.42,62,,15.536,percent of total Billed Charges,62% of total Billed Charges,19.42,62,,15.536,percent of total Billed Charges,62% of total Billed Charges,19.42,26.63,
BENEPROTEIN ORAL POWDER PACKET,72100,CDM,270,RC,,,Outpatient,,,31.33,21.931,,25.06,80,,20.048,percent of total Billed Charges,80% of Total Billed Charges,19.74,63,,15.792,percent of total Billed charges,63% of Total Billed Charges,19.42,62,,15.536,percent of total Billed Charges,62% of total BIlled charges,19.74,63,,15.792,percent of total Billed Charges,63% of total Billed Charges,26.63,85,,21.304,percent of total Billed Charges,85% of total Billed Charges,25.06,80,,20.048,percent of total Billed Charges,80% of total Billed Charges,19.42,62,,15.536,percent of total Billed Charges,62% of total Billed Charges,19.74,63,,15.792,percent of total Billed Charges,63% of total Billed Charges,19.42,62,,15.536,percent of total Billed Charges,62% of total Billed Charges,19.74,63,,15.792,percent of total billed charges,63% of total Billed Charges,19.42,62,,15.536,percent of total Billed Charges,62% of total Billed Charges,25.06,80,,20.048,percent of total Billed Charges,80% of Total Billed Charges,19.42,62,,15.536,percent of total Billed Charges,62% of total Billed Charges,19.42,62,,15.536,percent of total Billed Charges,62% of total Billed Charges,19.42,26.63,
BENEPROTEIN ORAL POWDER PACKET,72101,CDM,270,RC,,,Outpatient,,,54.46,38.122,,43.57,80,,34.856,percent of total Billed Charges,80% of Total Billed Charges,34.31,63,,27.448,percent of total Billed charges,63% of Total Billed Charges,33.77,62,,27.016,percent of total Billed Charges,62% of total BIlled charges,34.31,63,,27.448,percent of total Billed Charges,63% of total Billed Charges,46.29,85,,37.032,percent of total Billed Charges,85% of total Billed Charges,43.57,80,,34.856,percent of total Billed Charges,80% of total Billed Charges,33.77,62,,27.016,percent of total Billed Charges,62% of total Billed Charges,34.31,63,,27.448,percent of total Billed Charges,63% of total Billed Charges,33.77,62,,27.016,percent of total Billed Charges,62% of total Billed Charges,34.31,63,,27.448,percent of total billed charges,63% of total Billed Charges,33.77,62,,27.016,percent of total Billed Charges,62% of total Billed Charges,43.57,80,,34.856,percent of total Billed Charges,80% of Total Billed Charges,33.77,62,,27.016,percent of total Billed Charges,62% of total Billed Charges,33.77,62,,27.016,percent of total Billed Charges,62% of total Billed Charges,33.77,46.29,
BENEPROTEIN ORAL POWDER PACKET,70060,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71765,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72094,CDM,270,RC,,,Outpatient,,,17.12,11.984,,13.7,80,,10.96,percent of total Billed Charges,80% of Total Billed Charges,10.79,63,,8.632,percent of total Billed charges,63% of Total Billed Charges,10.61,62,,8.488,percent of total Billed Charges,62% of total BIlled charges,10.79,63,,8.632,percent of total Billed Charges,63% of total Billed Charges,14.55,85,,11.64,percent of total Billed Charges,85% of total Billed Charges,13.7,80,,10.96,percent of total Billed Charges,80% of total Billed Charges,10.61,62,,8.488,percent of total Billed Charges,62% of total Billed Charges,10.79,63,,8.632,percent of total Billed Charges,63% of total Billed Charges,10.61,62,,8.488,percent of total Billed Charges,62% of total Billed Charges,10.79,63,,8.632,percent of total billed charges,63% of total Billed Charges,10.61,62,,8.488,percent of total Billed Charges,62% of total Billed Charges,13.7,80,,10.96,percent of total Billed Charges,80% of Total Billed Charges,10.61,62,,8.488,percent of total Billed Charges,62% of total Billed Charges,10.61,62,,8.488,percent of total Billed Charges,62% of total Billed Charges,10.61,14.55,
BENEPROTEIN ORAL POWDER PACKET,70062,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70064,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70841,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72186,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70821,CDM,270,RC,,,Outpatient,,,9,6.3,,7.2,80,,5.76,percent of total Billed Charges,80% of Total Billed Charges,5.67,63,,4.536,percent of total Billed charges,63% of Total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total BIlled charges,5.67,63,,4.536,percent of total Billed Charges,63% of total Billed Charges,7.65,85,,6.12,percent of total Billed Charges,85% of total Billed Charges,7.2,80,,5.76,percent of total Billed Charges,80% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.67,63,,4.536,percent of total Billed Charges,63% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.67,63,,4.536,percent of total billed charges,63% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,7.2,80,,5.76,percent of total Billed Charges,80% of Total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.58,7.65,
BENEPROTEIN ORAL POWDER PACKET,70822,CDM,270,RC,,,Outpatient,,,14.5,10.15,,11.6,80,,9.28,percent of total Billed Charges,80% of Total Billed Charges,9.14,63,,7.312,percent of total Billed charges,63% of Total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total BIlled charges,9.14,63,,7.312,percent of total Billed Charges,63% of total Billed Charges,12.33,85,,9.864,percent of total Billed Charges,85% of total Billed Charges,11.6,80,,9.28,percent of total Billed Charges,80% of total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total Billed Charges,9.14,63,,7.312,percent of total Billed Charges,63% of total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total Billed Charges,9.14,63,,7.312,percent of total billed charges,63% of total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total Billed Charges,11.6,80,,9.28,percent of total Billed Charges,80% of Total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total Billed Charges,8.99,12.33,
BENEPROTEIN ORAL POWDER PACKET,70824,CDM,270,RC,,,Outpatient,,,17.5,12.25,,14,80,,11.2,percent of total Billed Charges,80% of Total Billed Charges,11.03,63,,8.824,percent of total Billed charges,63% of Total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total BIlled charges,11.03,63,,8.824,percent of total Billed Charges,63% of total Billed Charges,14.88,85,,11.904,percent of total Billed Charges,85% of total Billed Charges,14,80,,11.2,percent of total Billed Charges,80% of total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total Billed Charges,11.03,63,,8.824,percent of total Billed Charges,63% of total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total Billed Charges,11.03,63,,8.824,percent of total billed charges,63% of total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total Billed Charges,14,80,,11.2,percent of total Billed Charges,80% of Total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total Billed Charges,10.85,14.88,
BENEPROTEIN ORAL POWDER PACKET,150046,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
JEVITY 1.2 CAL ARC LIQ 24X8 OZ,72264,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
JEVITY 1.5 CAL ARC LIQ 24X8 OZ,72265,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
JEVITY 1.5C RTH SAFE SCREW CAP 8X1000ML,72266,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
JUVEN-NUTRITIONAL SUPPLEMENT Fruit Punch PWD Packet,72261,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
JUVEN-NUTRITIONAL SUPPLEMENT Orange PWD Packet,72262,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
JUVEN-NUTRITIONAL SUPPLEMENT Unflavored PWD Packet,72263,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70065,CDM,270,RC,,,Outpatient,,,51.45,36.015,,41.16,80,,32.928,percent of total Billed Charges,80% of Total Billed Charges,32.41,63,,25.928,percent of total Billed charges,63% of Total Billed Charges,31.9,62,,25.52,percent of total Billed Charges,62% of total BIlled charges,32.41,63,,25.928,percent of total Billed Charges,63% of total Billed Charges,43.73,85,,34.984,percent of total Billed Charges,85% of total Billed Charges,41.16,80,,32.928,percent of total Billed Charges,80% of total Billed Charges,31.9,62,,25.52,percent of total Billed Charges,62% of total Billed Charges,32.41,63,,25.928,percent of total Billed Charges,63% of total Billed Charges,31.9,62,,25.52,percent of total Billed Charges,62% of total Billed Charges,32.41,63,,25.928,percent of total billed charges,63% of total Billed Charges,31.9,62,,25.52,percent of total Billed Charges,62% of total Billed Charges,41.16,80,,32.928,percent of total Billed Charges,80% of Total Billed Charges,31.9,62,,25.52,percent of total Billed Charges,62% of total Billed Charges,31.9,62,,25.52,percent of total Billed Charges,62% of total Billed Charges,31.9,43.73,
BENEPROTEIN ORAL POWDER PACKET,70066,CDM,270,RC,,,Outpatient,,,37.49,26.243,,29.99,80,,23.992,percent of total Billed Charges,80% of Total Billed Charges,23.62,63,,18.896,percent of total Billed charges,63% of Total Billed Charges,23.24,62,,18.592,percent of total Billed Charges,62% of total BIlled charges,23.62,63,,18.896,percent of total Billed Charges,63% of total Billed Charges,31.87,85,,25.496,percent of total Billed Charges,85% of total Billed Charges,29.99,80,,23.992,percent of total Billed Charges,80% of total Billed Charges,23.24,62,,18.592,percent of total Billed Charges,62% of total Billed Charges,23.62,63,,18.896,percent of total Billed Charges,63% of total Billed Charges,23.24,62,,18.592,percent of total Billed Charges,62% of total Billed Charges,23.62,63,,18.896,percent of total billed charges,63% of total Billed Charges,23.24,62,,18.592,percent of total Billed Charges,62% of total Billed Charges,29.99,80,,23.992,percent of total Billed Charges,80% of Total Billed Charges,23.24,62,,18.592,percent of total Billed Charges,62% of total Billed Charges,23.24,62,,18.592,percent of total Billed Charges,62% of total Billed Charges,23.24,31.87,
BENEPROTEIN ORAL POWDER PACKET,70840,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70180,CDM,270,RC,,,Outpatient,,,16,11.2,,12.8,80,,10.24,percent of total Billed Charges,80% of Total Billed Charges,10.08,63,,8.064,percent of total Billed charges,63% of Total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total BIlled charges,10.08,63,,8.064,percent of total Billed Charges,63% of total Billed Charges,13.6,85,,10.88,percent of total Billed Charges,85% of total Billed Charges,12.8,80,,10.24,percent of total Billed Charges,80% of total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total Billed Charges,10.08,63,,8.064,percent of total Billed Charges,63% of total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total Billed Charges,10.08,63,,8.064,percent of total billed charges,63% of total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total Billed Charges,12.8,80,,10.24,percent of total Billed Charges,80% of Total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total Billed Charges,9.92,13.6,
BENEPROTEIN ORAL POWDER PACKET,72337,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70069,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70070,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70072,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70071,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70181,CDM,270,RC,,,Outpatient,,,7,4.9,,5.6,80,,4.48,percent of total Billed Charges,80% of Total Billed Charges,4.41,63,,3.528,percent of total Billed charges,63% of Total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total BIlled charges,4.41,63,,3.528,percent of total Billed Charges,63% of total Billed Charges,5.95,85,,4.76,percent of total Billed Charges,85% of total Billed Charges,5.6,80,,4.48,percent of total Billed Charges,80% of total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,4.41,63,,3.528,percent of total Billed Charges,63% of total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,4.41,63,,3.528,percent of total billed charges,63% of total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,5.6,80,,4.48,percent of total Billed Charges,80% of Total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,4.34,5.95,
BENEPROTEIN ORAL POWDER PACKET,70074,CDM,270,RC,,,Outpatient,,,17.5,12.25,,14,80,,11.2,percent of total Billed Charges,80% of Total Billed Charges,11.03,63,,8.824,percent of total Billed charges,63% of Total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total BIlled charges,11.03,63,,8.824,percent of total Billed Charges,63% of total Billed Charges,14.88,85,,11.904,percent of total Billed Charges,85% of total Billed Charges,14,80,,11.2,percent of total Billed Charges,80% of total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total Billed Charges,11.03,63,,8.824,percent of total Billed Charges,63% of total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total Billed Charges,11.03,63,,8.824,percent of total billed charges,63% of total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total Billed Charges,14,80,,11.2,percent of total Billed Charges,80% of Total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total Billed Charges,10.85,14.88,
BENEPROTEIN ORAL POWDER PACKET,70182,CDM,270,RC,,,Outpatient,,,7.88,5.516,,6.3,80,,5.04,percent of total Billed Charges,80% of Total Billed Charges,4.96,63,,3.968,percent of total Billed charges,63% of Total Billed Charges,4.89,62,,3.912,percent of total Billed Charges,62% of total BIlled charges,4.96,63,,3.968,percent of total Billed Charges,63% of total Billed Charges,6.7,85,,5.36,percent of total Billed Charges,85% of total Billed Charges,6.3,80,,5.04,percent of total Billed Charges,80% of total Billed Charges,4.89,62,,3.912,percent of total Billed Charges,62% of total Billed Charges,4.96,63,,3.968,percent of total Billed Charges,63% of total Billed Charges,4.89,62,,3.912,percent of total Billed Charges,62% of total Billed Charges,4.96,63,,3.968,percent of total billed charges,63% of total Billed Charges,4.89,62,,3.912,percent of total Billed Charges,62% of total Billed Charges,6.3,80,,5.04,percent of total Billed Charges,80% of Total Billed Charges,4.89,62,,3.912,percent of total Billed Charges,62% of total Billed Charges,4.89,62,,3.912,percent of total Billed Charges,62% of total Billed Charges,4.89,6.7,
BENEPROTEIN ORAL POWDER PACKET,71786,CDM,270,RC,,,Outpatient,,,49.14,34.398,,39.31,80,,31.448,percent of total Billed Charges,80% of Total Billed Charges,30.96,63,,24.768,percent of total Billed charges,63% of Total Billed Charges,30.47,62,,24.376,percent of total Billed Charges,62% of total BIlled charges,30.96,63,,24.768,percent of total Billed Charges,63% of total Billed Charges,41.77,85,,33.416,percent of total Billed Charges,85% of total Billed Charges,39.31,80,,31.448,percent of total Billed Charges,80% of total Billed Charges,30.47,62,,24.376,percent of total Billed Charges,62% of total Billed Charges,30.96,63,,24.768,percent of total Billed Charges,63% of total Billed Charges,30.47,62,,24.376,percent of total Billed Charges,62% of total Billed Charges,30.96,63,,24.768,percent of total billed charges,63% of total Billed Charges,30.47,62,,24.376,percent of total Billed Charges,62% of total Billed Charges,39.31,80,,31.448,percent of total Billed Charges,80% of Total Billed Charges,30.47,62,,24.376,percent of total Billed Charges,62% of total Billed Charges,30.47,62,,24.376,percent of total Billed Charges,62% of total Billed Charges,30.47,41.77,
BENEPROTEIN ORAL POWDER PACKET,71787,CDM,270,RC,,,Outpatient,,,86.61,60.627,,69.29,80,,55.432,percent of total Billed Charges,80% of Total Billed Charges,54.56,63,,43.648,percent of total Billed charges,63% of Total Billed Charges,53.7,62,,42.96,percent of total Billed Charges,62% of total BIlled charges,54.56,63,,43.648,percent of total Billed Charges,63% of total Billed Charges,73.62,85,,58.896,percent of total Billed Charges,85% of total Billed Charges,69.29,80,,55.432,percent of total Billed Charges,80% of total Billed Charges,53.7,62,,42.96,percent of total Billed Charges,62% of total Billed Charges,54.56,63,,43.648,percent of total Billed Charges,63% of total Billed Charges,53.7,62,,42.96,percent of total Billed Charges,62% of total Billed Charges,54.56,63,,43.648,percent of total billed charges,63% of total Billed Charges,53.7,62,,42.96,percent of total Billed Charges,62% of total Billed Charges,69.29,80,,55.432,percent of total Billed Charges,80% of Total Billed Charges,53.7,62,,42.96,percent of total Billed Charges,62% of total Billed Charges,53.7,62,,42.96,percent of total Billed Charges,62% of total Billed Charges,53.7,73.62,
BENEPROTEIN ORAL POWDER PACKET,71788,CDM,270,RC,,,Outpatient,,,62.37,43.659,,49.9,80,,39.92,percent of total Billed Charges,80% of Total Billed Charges,39.29,63,,31.432,percent of total Billed charges,63% of Total Billed Charges,38.67,62,,30.936,percent of total Billed Charges,62% of total BIlled charges,39.29,63,,31.432,percent of total Billed Charges,63% of total Billed Charges,53.01,85,,42.408,percent of total Billed Charges,85% of total Billed Charges,49.9,80,,39.92,percent of total Billed Charges,80% of total Billed Charges,38.67,62,,30.936,percent of total Billed Charges,62% of total Billed Charges,39.29,63,,31.432,percent of total Billed Charges,63% of total Billed Charges,38.67,62,,30.936,percent of total Billed Charges,62% of total Billed Charges,39.29,63,,31.432,percent of total billed charges,63% of total Billed Charges,38.67,62,,30.936,percent of total Billed Charges,62% of total Billed Charges,49.9,80,,39.92,percent of total Billed Charges,80% of Total Billed Charges,38.67,62,,30.936,percent of total Billed Charges,62% of total Billed Charges,38.67,62,,30.936,percent of total Billed Charges,62% of total Billed Charges,38.67,53.01,
BENEPROTEIN ORAL POWDER PACKET,70075,CDM,270,RC,,,Outpatient,,,13.62,9.534,,10.9,80,,8.72,percent of total Billed Charges,80% of Total Billed Charges,8.58,63,,6.864,percent of total Billed charges,63% of Total Billed Charges,8.44,62,,6.752,percent of total Billed Charges,62% of total BIlled charges,8.58,63,,6.864,percent of total Billed Charges,63% of total Billed Charges,11.58,85,,9.264,percent of total Billed Charges,85% of total Billed Charges,10.9,80,,8.72,percent of total Billed Charges,80% of total Billed Charges,8.44,62,,6.752,percent of total Billed Charges,62% of total Billed Charges,8.58,63,,6.864,percent of total Billed Charges,63% of total Billed Charges,8.44,62,,6.752,percent of total Billed Charges,62% of total Billed Charges,8.58,63,,6.864,percent of total billed charges,63% of total Billed Charges,8.44,62,,6.752,percent of total Billed Charges,62% of total Billed Charges,10.9,80,,8.72,percent of total Billed Charges,80% of Total Billed Charges,8.44,62,,6.752,percent of total Billed Charges,62% of total Billed Charges,8.44,62,,6.752,percent of total Billed Charges,62% of total Billed Charges,8.44,11.58,
BENEPROTEIN ORAL POWDER PACKET,50056,CDM,270,RC,,,Outpatient,,,35.77,25.039,,28.62,80,,22.896,percent of total Billed Charges,80% of Total Billed Charges,22.54,63,,18.032,percent of total Billed charges,63% of Total Billed Charges,22.18,62,,17.744,percent of total Billed Charges,62% of total BIlled charges,22.54,63,,18.032,percent of total Billed Charges,63% of total Billed Charges,30.4,85,,24.32,percent of total Billed Charges,85% of total Billed Charges,28.62,80,,22.896,percent of total Billed Charges,80% of total Billed Charges,22.18,62,,17.744,percent of total Billed Charges,62% of total Billed Charges,22.54,63,,18.032,percent of total Billed Charges,63% of total Billed Charges,22.18,62,,17.744,percent of total Billed Charges,62% of total Billed Charges,22.54,63,,18.032,percent of total billed charges,63% of total Billed Charges,22.18,62,,17.744,percent of total Billed Charges,62% of total Billed Charges,28.62,80,,22.896,percent of total Billed Charges,80% of Total Billed Charges,22.18,62,,17.744,percent of total Billed Charges,62% of total Billed Charges,22.18,62,,17.744,percent of total Billed Charges,62% of total Billed Charges,22.18,30.4,
BENEPROTEIN ORAL POWDER PACKET,50058,CDM,270,RC,,,Outpatient,,,20.97,14.679,,16.78,80,,13.424,percent of total Billed Charges,80% of Total Billed Charges,13.21,63,,10.568,percent of total Billed charges,63% of Total Billed Charges,13,62,,10.4,percent of total Billed Charges,62% of total BIlled charges,13.21,63,,10.568,percent of total Billed Charges,63% of total Billed Charges,17.82,85,,14.256,percent of total Billed Charges,85% of total Billed Charges,16.78,80,,13.424,percent of total Billed Charges,80% of total Billed Charges,13,62,,10.4,percent of total Billed Charges,62% of total Billed Charges,13.21,63,,10.568,percent of total Billed Charges,63% of total Billed Charges,13,62,,10.4,percent of total Billed Charges,62% of total Billed Charges,13.21,63,,10.568,percent of total billed charges,63% of total Billed Charges,13,62,,10.4,percent of total Billed Charges,62% of total Billed Charges,16.78,80,,13.424,percent of total Billed Charges,80% of Total Billed Charges,13,62,,10.4,percent of total Billed Charges,62% of total Billed Charges,13,62,,10.4,percent of total Billed Charges,62% of total Billed Charges,13,17.82,
BENEPROTEIN ORAL POWDER PACKET,50059,CDM,270,RC,,,Outpatient,,,8.19,5.733,,6.55,80,,5.24,percent of total Billed Charges,80% of Total Billed Charges,5.16,63,,4.128,percent of total Billed charges,63% of Total Billed Charges,5.08,62,,4.064,percent of total Billed Charges,62% of total BIlled charges,5.16,63,,4.128,percent of total Billed Charges,63% of total Billed Charges,6.96,85,,5.568,percent of total Billed Charges,85% of total Billed Charges,6.55,80,,5.24,percent of total Billed Charges,80% of total Billed Charges,5.08,62,,4.064,percent of total Billed Charges,62% of total Billed Charges,5.16,63,,4.128,percent of total Billed Charges,63% of total Billed Charges,5.08,62,,4.064,percent of total Billed Charges,62% of total Billed Charges,5.16,63,,4.128,percent of total billed charges,63% of total Billed Charges,5.08,62,,4.064,percent of total Billed Charges,62% of total Billed Charges,6.55,80,,5.24,percent of total Billed Charges,80% of Total Billed Charges,5.08,62,,4.064,percent of total Billed Charges,62% of total Billed Charges,5.08,62,,4.064,percent of total Billed Charges,62% of total Billed Charges,5.08,6.96,
BENEPROTEIN ORAL POWDER PACKET,71680,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70754,CDM,270,RC,,,Outpatient,,,12.15,8.505,,9.72,80,,7.776,percent of total Billed Charges,80% of Total Billed Charges,7.65,63,,6.12,percent of total Billed charges,63% of Total Billed Charges,7.53,62,,6.024,percent of total Billed Charges,62% of total BIlled charges,7.65,63,,6.12,percent of total Billed Charges,63% of total Billed Charges,10.33,85,,8.264,percent of total Billed Charges,85% of total Billed Charges,9.72,80,,7.776,percent of total Billed Charges,80% of total Billed Charges,7.53,62,,6.024,percent of total Billed Charges,62% of total Billed Charges,7.65,63,,6.12,percent of total Billed Charges,63% of total Billed Charges,7.53,62,,6.024,percent of total Billed Charges,62% of total Billed Charges,7.65,63,,6.12,percent of total billed charges,63% of total Billed Charges,7.53,62,,6.024,percent of total Billed Charges,62% of total Billed Charges,9.72,80,,7.776,percent of total Billed Charges,80% of Total Billed Charges,7.53,62,,6.024,percent of total Billed Charges,62% of total Billed Charges,7.53,62,,6.024,percent of total Billed Charges,62% of total Billed Charges,7.53,10.33,
BENEPROTEIN ORAL POWDER PACKET,72320,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70076,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72057,CDM,270,RC,,,Outpatient,,,18.55,12.985,,14.84,80,,11.872,percent of total Billed Charges,80% of Total Billed Charges,11.69,63,,9.352,percent of total Billed charges,63% of Total Billed Charges,11.5,62,,9.2,percent of total Billed Charges,62% of total BIlled charges,11.69,63,,9.352,percent of total Billed Charges,63% of total Billed Charges,15.77,85,,12.616,percent of total Billed Charges,85% of total Billed Charges,14.84,80,,11.872,percent of total Billed Charges,80% of total Billed Charges,11.5,62,,9.2,percent of total Billed Charges,62% of total Billed Charges,11.69,63,,9.352,percent of total Billed Charges,63% of total Billed Charges,11.5,62,,9.2,percent of total Billed Charges,62% of total Billed Charges,11.69,63,,9.352,percent of total billed charges,63% of total Billed Charges,11.5,62,,9.2,percent of total Billed Charges,62% of total Billed Charges,14.84,80,,11.872,percent of total Billed Charges,80% of Total Billed Charges,11.5,62,,9.2,percent of total Billed Charges,62% of total Billed Charges,11.5,62,,9.2,percent of total Billed Charges,62% of total Billed Charges,11.5,15.77,
BENEPROTEIN ORAL POWDER PACKET,72056,CDM,270,RC,,,Outpatient,,,41.9,29.33,,33.52,80,,26.816,percent of total Billed Charges,80% of Total Billed Charges,26.4,63,,21.12,percent of total Billed charges,63% of Total Billed Charges,25.98,62,,20.784,percent of total Billed Charges,62% of total BIlled charges,26.4,63,,21.12,percent of total Billed Charges,63% of total Billed Charges,35.62,85,,28.496,percent of total Billed Charges,85% of total Billed Charges,33.52,80,,26.816,percent of total Billed Charges,80% of total Billed Charges,25.98,62,,20.784,percent of total Billed Charges,62% of total Billed Charges,26.4,63,,21.12,percent of total Billed Charges,63% of total Billed Charges,25.98,62,,20.784,percent of total Billed Charges,62% of total Billed Charges,26.4,63,,21.12,percent of total billed charges,63% of total Billed Charges,25.98,62,,20.784,percent of total Billed Charges,62% of total Billed Charges,33.52,80,,26.816,percent of total Billed Charges,80% of Total Billed Charges,25.98,62,,20.784,percent of total Billed Charges,62% of total Billed Charges,25.98,62,,20.784,percent of total Billed Charges,62% of total Billed Charges,25.98,35.62,
BENEPROTEIN ORAL POWDER PACKET,71784,CDM,270,RC,,,Outpatient,,,8,5.6,,6.4,80,,5.12,percent of total Billed Charges,80% of Total Billed Charges,5.04,63,,4.032,percent of total Billed charges,63% of Total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total BIlled charges,5.04,63,,4.032,percent of total Billed Charges,63% of total Billed Charges,6.8,85,,5.44,percent of total Billed Charges,85% of total Billed Charges,6.4,80,,5.12,percent of total Billed Charges,80% of total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,5.04,63,,4.032,percent of total Billed Charges,63% of total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,5.04,63,,4.032,percent of total billed charges,63% of total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,6.4,80,,5.12,percent of total Billed Charges,80% of Total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,4.96,6.8,
BENEPROTEIN ORAL POWDER PACKET,72243,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72199,CDM,270,RC,,,Outpatient,,,27.5,19.25,,22,80,,17.6,percent of total Billed Charges,80% of Total Billed Charges,17.33,63,,13.864,percent of total Billed charges,63% of Total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total BIlled charges,17.33,63,,13.864,percent of total Billed Charges,63% of total Billed Charges,23.38,85,,18.704,percent of total Billed Charges,85% of total Billed Charges,22,80,,17.6,percent of total Billed Charges,80% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.33,63,,13.864,percent of total Billed Charges,63% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.33,63,,13.864,percent of total billed charges,63% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,22,80,,17.6,percent of total Billed Charges,80% of Total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.05,23.38,
BENEPROTEIN ORAL POWDER PACKET,72200,CDM,270,RC,,,Outpatient,,,27.5,19.25,,22,80,,17.6,percent of total Billed Charges,80% of Total Billed Charges,17.33,63,,13.864,percent of total Billed charges,63% of Total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total BIlled charges,17.33,63,,13.864,percent of total Billed Charges,63% of total Billed Charges,23.38,85,,18.704,percent of total Billed Charges,85% of total Billed Charges,22,80,,17.6,percent of total Billed Charges,80% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.33,63,,13.864,percent of total Billed Charges,63% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.33,63,,13.864,percent of total billed charges,63% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,22,80,,17.6,percent of total Billed Charges,80% of Total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.05,23.38,
BENEPROTEIN ORAL POWDER PACKET,150012,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,150064,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,150063,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,150068,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,150072,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72369,CDM,270,RC,,,Outpatient,,,21.04,14.728,,16.83,80,,13.464,percent of total Billed Charges,80% of Total Billed Charges,13.26,63,,10.608,percent of total Billed charges,63% of Total Billed Charges,13.04,62,,10.432,percent of total Billed Charges,62% of total BIlled charges,13.26,63,,10.608,percent of total Billed Charges,63% of total Billed Charges,17.88,85,,14.304,percent of total Billed Charges,85% of total Billed Charges,16.83,80,,13.464,percent of total Billed Charges,80% of total Billed Charges,13.04,62,,10.432,percent of total Billed Charges,62% of total Billed Charges,13.26,63,,10.608,percent of total Billed Charges,63% of total Billed Charges,13.04,62,,10.432,percent of total Billed Charges,62% of total Billed Charges,13.26,63,,10.608,percent of total billed charges,63% of total Billed Charges,13.04,62,,10.432,percent of total Billed Charges,62% of total Billed Charges,16.83,80,,13.464,percent of total Billed Charges,80% of Total Billed Charges,13.04,62,,10.432,percent of total Billed Charges,62% of total Billed Charges,13.04,62,,10.432,percent of total Billed Charges,62% of total Billed Charges,13.04,17.88,
BENEPROTEIN ORAL POWDER PACKET,CDM,CDM,270,RC,,,Outpatient,,,17.99,12.593,,14.39,80,,11.512,percent of total Billed Charges,80% of Total Billed Charges,11.33,63,,9.064,percent of total Billed charges,63% of Total Billed Charges,11.15,62,,8.92,percent of total Billed Charges,62% of total BIlled charges,11.33,63,,9.064,percent of total Billed Charges,63% of total Billed Charges,15.29,85,,12.232,percent of total Billed Charges,85% of total Billed Charges,14.39,80,,11.512,percent of total Billed Charges,80% of total Billed Charges,11.15,62,,8.92,percent of total Billed Charges,62% of total Billed Charges,11.33,63,,9.064,percent of total Billed Charges,63% of total Billed Charges,11.15,62,,8.92,percent of total Billed Charges,62% of total Billed Charges,11.33,63,,9.064,percent of total billed charges,63% of total Billed Charges,11.15,62,,8.92,percent of total Billed Charges,62% of total Billed Charges,14.39,80,,11.512,percent of total Billed Charges,80% of Total Billed Charges,11.15,62,,8.92,percent of total Billed Charges,62% of total Billed Charges,11.15,62,,8.92,percent of total Billed Charges,62% of total Billed Charges,11.15,15.29,
BENEPROTEIN ORAL POWDER PACKET,72367,CDM,270,RC,,,Outpatient,,,17.99,12.593,,14.39,80,,11.512,percent of total Billed Charges,80% of Total Billed Charges,11.33,63,,9.064,percent of total Billed charges,63% of Total Billed Charges,11.15,62,,8.92,percent of total Billed Charges,62% of total BIlled charges,11.33,63,,9.064,percent of total Billed Charges,63% of total Billed Charges,15.29,85,,12.232,percent of total Billed Charges,85% of total Billed Charges,14.39,80,,11.512,percent of total Billed Charges,80% of total Billed Charges,11.15,62,,8.92,percent of total Billed Charges,62% of total Billed Charges,11.33,63,,9.064,percent of total Billed Charges,63% of total Billed Charges,11.15,62,,8.92,percent of total Billed Charges,62% of total Billed Charges,11.33,63,,9.064,percent of total billed charges,63% of total Billed Charges,11.15,62,,8.92,percent of total Billed Charges,62% of total Billed Charges,14.39,80,,11.512,percent of total Billed Charges,80% of Total Billed Charges,11.15,62,,8.92,percent of total Billed Charges,62% of total Billed Charges,11.15,62,,8.92,percent of total Billed Charges,62% of total Billed Charges,11.15,15.29,
BENEPROTEIN ORAL POWDER PACKET,40004,CDM,270,RC,,,Outpatient,,,7.44,5.208,,5.95,80,,4.76,percent of total Billed Charges,80% of Total Billed Charges,4.69,63,,3.752,percent of total Billed charges,63% of Total Billed Charges,4.61,62,,3.688,percent of total Billed Charges,62% of total BIlled charges,4.69,63,,3.752,percent of total Billed Charges,63% of total Billed Charges,6.32,85,,5.056,percent of total Billed Charges,85% of total Billed Charges,5.95,80,,4.76,percent of total Billed Charges,80% of total Billed Charges,4.61,62,,3.688,percent of total Billed Charges,62% of total Billed Charges,4.69,63,,3.752,percent of total Billed Charges,63% of total Billed Charges,4.61,62,,3.688,percent of total Billed Charges,62% of total Billed Charges,4.69,63,,3.752,percent of total billed charges,63% of total Billed Charges,4.61,62,,3.688,percent of total Billed Charges,62% of total Billed Charges,5.95,80,,4.76,percent of total Billed Charges,80% of Total Billed Charges,4.61,62,,3.688,percent of total Billed Charges,62% of total Billed Charges,4.61,62,,3.688,percent of total Billed Charges,62% of total Billed Charges,4.61,6.32,
BENEPROTEIN ORAL POWDER PACKET,71686,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70083,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72202,CDM,270,RC,,,Outpatient,,,27.5,19.25,,22,80,,17.6,percent of total Billed Charges,80% of Total Billed Charges,17.33,63,,13.864,percent of total Billed charges,63% of Total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total BIlled charges,17.33,63,,13.864,percent of total Billed Charges,63% of total Billed Charges,23.38,85,,18.704,percent of total Billed Charges,85% of total Billed Charges,22,80,,17.6,percent of total Billed Charges,80% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.33,63,,13.864,percent of total Billed Charges,63% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.33,63,,13.864,percent of total billed charges,63% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,22,80,,17.6,percent of total Billed Charges,80% of Total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.05,23.38,
BENEPROTEIN ORAL POWDER PACKET,72201,CDM,270,RC,,,Outpatient,,,27.5,19.25,,22,80,,17.6,percent of total Billed Charges,80% of Total Billed Charges,17.33,63,,13.864,percent of total Billed charges,63% of Total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total BIlled charges,17.33,63,,13.864,percent of total Billed Charges,63% of total Billed Charges,23.38,85,,18.704,percent of total Billed Charges,85% of total Billed Charges,22,80,,17.6,percent of total Billed Charges,80% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.33,63,,13.864,percent of total Billed Charges,63% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.33,63,,13.864,percent of total billed charges,63% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,22,80,,17.6,percent of total Billed Charges,80% of Total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.05,23.38,
BENEPROTEIN ORAL POWDER PACKET,72203,CDM,270,RC,,,Outpatient,,,11.38,7.966,,9.1,80,,7.28,percent of total Billed Charges,80% of Total Billed Charges,7.17,63,,5.736,percent of total Billed charges,63% of Total Billed Charges,7.06,62,,5.648,percent of total Billed Charges,62% of total BIlled charges,7.17,63,,5.736,percent of total Billed Charges,63% of total Billed Charges,9.67,85,,7.736,percent of total Billed Charges,85% of total Billed Charges,9.1,80,,7.28,percent of total Billed Charges,80% of total Billed Charges,7.06,62,,5.648,percent of total Billed Charges,62% of total Billed Charges,7.17,63,,5.736,percent of total Billed Charges,63% of total Billed Charges,7.06,62,,5.648,percent of total Billed Charges,62% of total Billed Charges,7.17,63,,5.736,percent of total billed charges,63% of total Billed Charges,7.06,62,,5.648,percent of total Billed Charges,62% of total Billed Charges,9.1,80,,7.28,percent of total Billed Charges,80% of Total Billed Charges,7.06,62,,5.648,percent of total Billed Charges,62% of total Billed Charges,7.06,62,,5.648,percent of total Billed Charges,62% of total Billed Charges,7.06,9.67,
BENEPROTEIN ORAL POWDER PACKET,72204,CDM,270,RC,,,Outpatient,,,27.5,19.25,,22,80,,17.6,percent of total Billed Charges,80% of Total Billed Charges,17.33,63,,13.864,percent of total Billed charges,63% of Total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total BIlled charges,17.33,63,,13.864,percent of total Billed Charges,63% of total Billed Charges,23.38,85,,18.704,percent of total Billed Charges,85% of total Billed Charges,22,80,,17.6,percent of total Billed Charges,80% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.33,63,,13.864,percent of total Billed Charges,63% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.33,63,,13.864,percent of total billed charges,63% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,22,80,,17.6,percent of total Billed Charges,80% of Total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.05,23.38,
BENEPROTEIN ORAL POWDER PACKET,70900,CDM,270,RC,,,Outpatient,,,23,16.1,,18.4,80,,14.72,percent of total Billed Charges,80% of Total Billed Charges,14.49,63,,11.592,percent of total Billed charges,63% of Total Billed Charges,14.26,62,,11.408,percent of total Billed Charges,62% of total BIlled charges,14.49,63,,11.592,percent of total Billed Charges,63% of total Billed Charges,19.55,85,,15.64,percent of total Billed Charges,85% of total Billed Charges,18.4,80,,14.72,percent of total Billed Charges,80% of total Billed Charges,14.26,62,,11.408,percent of total Billed Charges,62% of total Billed Charges,14.49,63,,11.592,percent of total Billed Charges,63% of total Billed Charges,14.26,62,,11.408,percent of total Billed Charges,62% of total Billed Charges,14.49,63,,11.592,percent of total billed charges,63% of total Billed Charges,14.26,62,,11.408,percent of total Billed Charges,62% of total Billed Charges,18.4,80,,14.72,percent of total Billed Charges,80% of Total Billed Charges,14.26,62,,11.408,percent of total Billed Charges,62% of total Billed Charges,14.26,62,,11.408,percent of total Billed Charges,62% of total Billed Charges,14.26,19.55,
BENEPROTEIN ORAL POWDER PACKET,72310,CDM,270,RC,,,Outpatient,,,40.26,28.182,,32.21,80,,25.768,percent of total Billed Charges,80% of Total Billed Charges,25.36,63,,20.288,percent of total Billed charges,63% of Total Billed Charges,24.96,62,,19.968,percent of total Billed Charges,62% of total BIlled charges,25.36,63,,20.288,percent of total Billed Charges,63% of total Billed Charges,34.22,85,,27.376,percent of total Billed Charges,85% of total Billed Charges,32.21,80,,25.768,percent of total Billed Charges,80% of total Billed Charges,24.96,62,,19.968,percent of total Billed Charges,62% of total Billed Charges,25.36,63,,20.288,percent of total Billed Charges,63% of total Billed Charges,24.96,62,,19.968,percent of total Billed Charges,62% of total Billed Charges,25.36,63,,20.288,percent of total billed charges,63% of total Billed Charges,24.96,62,,19.968,percent of total Billed Charges,62% of total Billed Charges,32.21,80,,25.768,percent of total Billed Charges,80% of Total Billed Charges,24.96,62,,19.968,percent of total Billed Charges,62% of total Billed Charges,24.96,62,,19.968,percent of total Billed Charges,62% of total Billed Charges,24.96,34.22,
BENEPROTEIN ORAL POWDER PACKET,72311,CDM,270,RC,,,Outpatient,,,23.14,16.198,,18.51,80,,14.808,percent of total Billed Charges,80% of Total Billed Charges,14.58,63,,11.664,percent of total Billed charges,63% of Total Billed Charges,14.35,62,,11.48,percent of total Billed Charges,62% of total BIlled charges,14.58,63,,11.664,percent of total Billed Charges,63% of total Billed Charges,19.67,85,,15.736,percent of total Billed Charges,85% of total Billed Charges,18.51,80,,14.808,percent of total Billed Charges,80% of total Billed Charges,14.35,62,,11.48,percent of total Billed Charges,62% of total Billed Charges,14.58,63,,11.664,percent of total Billed Charges,63% of total Billed Charges,14.35,62,,11.48,percent of total Billed Charges,62% of total Billed Charges,14.58,63,,11.664,percent of total billed charges,63% of total Billed Charges,14.35,62,,11.48,percent of total Billed Charges,62% of total Billed Charges,18.51,80,,14.808,percent of total Billed Charges,80% of Total Billed Charges,14.35,62,,11.48,percent of total Billed Charges,62% of total Billed Charges,14.35,62,,11.48,percent of total Billed Charges,62% of total Billed Charges,14.35,19.67,
BENEPROTEIN ORAL POWDER PACKET,70668,CDM,270,RC,,,Outpatient,,,117.85,82.495,,94.28,80,,75.424,percent of total Billed Charges,80% of Total Billed Charges,74.25,63,,59.4,percent of total Billed charges,63% of Total Billed Charges,73.07,62,,58.456,percent of total Billed Charges,62% of total BIlled charges,74.25,63,,59.4,percent of total Billed Charges,63% of total Billed Charges,100.17,85,,80.136,percent of total Billed Charges,85% of total Billed Charges,94.28,80,,75.424,percent of total Billed Charges,80% of total Billed Charges,73.07,62,,58.456,percent of total Billed Charges,62% of total Billed Charges,74.25,63,,59.4,percent of total Billed Charges,63% of total Billed Charges,73.07,62,,58.456,percent of total Billed Charges,62% of total Billed Charges,74.25,63,,59.4,percent of total billed charges,63% of total Billed Charges,73.07,62,,58.456,percent of total Billed Charges,62% of total Billed Charges,94.28,80,,75.424,percent of total Billed Charges,80% of Total Billed Charges,73.07,62,,58.456,percent of total Billed Charges,62% of total Billed Charges,73.07,62,,58.456,percent of total Billed Charges,62% of total Billed Charges,73.07,100.17,
BENEPROTEIN ORAL POWDER PACKET,70085,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72177,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72180,CDM,270,RC,,,Outpatient,,,104.5,73.15,,83.6,80,,66.88,percent of total Billed Charges,80% of Total Billed Charges,65.84,63,,52.672,percent of total Billed charges,63% of Total Billed Charges,64.79,62,,51.832,percent of total Billed Charges,62% of total BIlled charges,65.84,63,,52.672,percent of total Billed Charges,63% of total Billed Charges,88.83,85,,71.064,percent of total Billed Charges,85% of total Billed Charges,83.6,80,,66.88,percent of total Billed Charges,80% of total Billed Charges,64.79,62,,51.832,percent of total Billed Charges,62% of total Billed Charges,65.84,63,,52.672,percent of total Billed Charges,63% of total Billed Charges,64.79,62,,51.832,percent of total Billed Charges,62% of total Billed Charges,65.84,63,,52.672,percent of total billed charges,63% of total Billed Charges,64.79,62,,51.832,percent of total Billed Charges,62% of total Billed Charges,83.6,80,,66.88,percent of total Billed Charges,80% of Total Billed Charges,64.79,62,,51.832,percent of total Billed Charges,62% of total Billed Charges,64.79,62,,51.832,percent of total Billed Charges,62% of total Billed Charges,64.79,88.83,
BENEPROTEIN ORAL POWDER PACKET,72110,CDM,270,RC,,,Outpatient,,,6.41,4.487,,5.13,80,,4.104,percent of total Billed Charges,80% of Total Billed Charges,4.04,63,,3.232,percent of total Billed charges,63% of Total Billed Charges,3.97,62,,3.176,percent of total Billed Charges,62% of total BIlled charges,4.04,63,,3.232,percent of total Billed Charges,63% of total Billed Charges,5.45,85,,4.36,percent of total Billed Charges,85% of total Billed Charges,5.13,80,,4.104,percent of total Billed Charges,80% of total Billed Charges,3.97,62,,3.176,percent of total Billed Charges,62% of total Billed Charges,4.04,63,,3.232,percent of total Billed Charges,63% of total Billed Charges,3.97,62,,3.176,percent of total Billed Charges,62% of total Billed Charges,4.04,63,,3.232,percent of total billed charges,63% of total Billed Charges,3.97,62,,3.176,percent of total Billed Charges,62% of total Billed Charges,5.13,80,,4.104,percent of total Billed Charges,80% of Total Billed Charges,3.97,62,,3.176,percent of total Billed Charges,62% of total Billed Charges,3.97,62,,3.176,percent of total Billed Charges,62% of total Billed Charges,3.97,5.45,
BENEPROTEIN ORAL POWDER PACKET,72109,CDM,270,RC,,,Outpatient,,,6.41,4.487,,5.13,80,,4.104,percent of total Billed Charges,80% of Total Billed Charges,4.04,63,,3.232,percent of total Billed charges,63% of Total Billed Charges,3.97,62,,3.176,percent of total Billed Charges,62% of total BIlled charges,4.04,63,,3.232,percent of total Billed Charges,63% of total Billed Charges,5.45,85,,4.36,percent of total Billed Charges,85% of total Billed Charges,5.13,80,,4.104,percent of total Billed Charges,80% of total Billed Charges,3.97,62,,3.176,percent of total Billed Charges,62% of total Billed Charges,4.04,63,,3.232,percent of total Billed Charges,63% of total Billed Charges,3.97,62,,3.176,percent of total Billed Charges,62% of total Billed Charges,4.04,63,,3.232,percent of total billed charges,63% of total Billed Charges,3.97,62,,3.176,percent of total Billed Charges,62% of total Billed Charges,5.13,80,,4.104,percent of total Billed Charges,80% of Total Billed Charges,3.97,62,,3.176,percent of total Billed Charges,62% of total Billed Charges,3.97,62,,3.176,percent of total Billed Charges,62% of total Billed Charges,3.97,5.45,
BENEPROTEIN ORAL POWDER PACKET,72108,CDM,270,RC,,,Outpatient,,,5.95,4.165,,4.76,80,,3.808,percent of total Billed Charges,80% of Total Billed Charges,3.75,63,,3,percent of total Billed charges,63% of Total Billed Charges,3.69,62,,2.952,percent of total Billed Charges,62% of total BIlled charges,3.75,63,,3,percent of total Billed Charges,63% of total Billed Charges,5.06,85,,4.048,percent of total Billed Charges,85% of total Billed Charges,4.76,80,,3.808,percent of total Billed Charges,80% of total Billed Charges,3.69,62,,2.952,percent of total Billed Charges,62% of total Billed Charges,3.75,63,,3,percent of total Billed Charges,63% of total Billed Charges,3.69,62,,2.952,percent of total Billed Charges,62% of total Billed Charges,3.75,63,,3,percent of total billed charges,63% of total Billed Charges,3.69,62,,2.952,percent of total Billed Charges,62% of total Billed Charges,4.76,80,,3.808,percent of total Billed Charges,80% of Total Billed Charges,3.69,62,,2.952,percent of total Billed Charges,62% of total Billed Charges,3.69,62,,2.952,percent of total Billed Charges,62% of total Billed Charges,3.69,5.06,
BENEPROTEIN ORAL POWDER PACKET,130026,CDM,270,RC,,,Outpatient,,,6.34,4.438,,5.07,80,,4.056,percent of total Billed Charges,80% of Total Billed Charges,3.99,63,,3.192,percent of total Billed charges,63% of Total Billed Charges,3.93,62,,3.144,percent of total Billed Charges,62% of total BIlled charges,3.99,63,,3.192,percent of total Billed Charges,63% of total Billed Charges,5.39,85,,4.312,percent of total Billed Charges,85% of total Billed Charges,5.07,80,,4.056,percent of total Billed Charges,80% of total Billed Charges,3.93,62,,3.144,percent of total Billed Charges,62% of total Billed Charges,3.99,63,,3.192,percent of total Billed Charges,63% of total Billed Charges,3.93,62,,3.144,percent of total Billed Charges,62% of total Billed Charges,3.99,63,,3.192,percent of total billed charges,63% of total Billed Charges,3.93,62,,3.144,percent of total Billed Charges,62% of total Billed Charges,5.07,80,,4.056,percent of total Billed Charges,80% of Total Billed Charges,3.93,62,,3.144,percent of total Billed Charges,62% of total Billed Charges,3.93,62,,3.144,percent of total Billed Charges,62% of total Billed Charges,3.93,5.39,
BENEPROTEIN ORAL POWDER PACKET,130028,CDM,270,RC,,,Outpatient,,,6.3,4.41,,5.04,80,,4.032,percent of total Billed Charges,80% of Total Billed Charges,3.97,63,,3.176,percent of total Billed charges,63% of Total Billed Charges,3.91,62,,3.128,percent of total Billed Charges,62% of total BIlled charges,3.97,63,,3.176,percent of total Billed Charges,63% of total Billed Charges,5.36,85,,4.288,percent of total Billed Charges,85% of total Billed Charges,5.04,80,,4.032,percent of total Billed Charges,80% of total Billed Charges,3.91,62,,3.128,percent of total Billed Charges,62% of total Billed Charges,3.97,63,,3.176,percent of total Billed Charges,63% of total Billed Charges,3.91,62,,3.128,percent of total Billed Charges,62% of total Billed Charges,3.97,63,,3.176,percent of total billed charges,63% of total Billed Charges,3.91,62,,3.128,percent of total Billed Charges,62% of total Billed Charges,5.04,80,,4.032,percent of total Billed Charges,80% of Total Billed Charges,3.91,62,,3.128,percent of total Billed Charges,62% of total Billed Charges,3.91,62,,3.128,percent of total Billed Charges,62% of total Billed Charges,3.91,5.36,
BENEPROTEIN ORAL POWDER PACKET,150023,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72312,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72091,CDM,270,RC,,,Outpatient,,,22.19,15.533,,17.75,80,,14.2,percent of total Billed Charges,80% of Total Billed Charges,13.98,63,,11.184,percent of total Billed charges,63% of Total Billed Charges,13.76,62,,11.008,percent of total Billed Charges,62% of total BIlled charges,13.98,63,,11.184,percent of total Billed Charges,63% of total Billed Charges,18.86,85,,15.088,percent of total Billed Charges,85% of total Billed Charges,17.75,80,,14.2,percent of total Billed Charges,80% of total Billed Charges,13.76,62,,11.008,percent of total Billed Charges,62% of total Billed Charges,13.98,63,,11.184,percent of total Billed Charges,63% of total Billed Charges,13.76,62,,11.008,percent of total Billed Charges,62% of total Billed Charges,13.98,63,,11.184,percent of total billed charges,63% of total Billed Charges,13.76,62,,11.008,percent of total Billed Charges,62% of total Billed Charges,17.75,80,,14.2,percent of total Billed Charges,80% of Total Billed Charges,13.76,62,,11.008,percent of total Billed Charges,62% of total Billed Charges,13.76,62,,11.008,percent of total Billed Charges,62% of total Billed Charges,13.76,18.86,
NEPRO CARB RTH SAFE SCREW LIQ 8X1000ML,72269,CDM,270,RC,,,Outpatient,,,7.03,4.921,,5.62,80,,4.496,percent of total Billed Charges,80% of Total Billed Charges,4.43,63,,3.544,percent of total Billed charges,63% of Total Billed Charges,4.36,62,,3.488,percent of total Billed Charges,62% of total BIlled charges,4.43,63,,3.544,percent of total Billed Charges,63% of total Billed Charges,5.98,85,,4.784,percent of total Billed Charges,85% of total Billed Charges,5.62,80,,4.496,percent of total Billed Charges,80% of total Billed Charges,4.36,62,,3.488,percent of total Billed Charges,62% of total Billed Charges,4.43,63,,3.544,percent of total Billed Charges,63% of total Billed Charges,4.36,62,,3.488,percent of total Billed Charges,62% of total Billed Charges,4.43,63,,3.544,percent of total billed charges,63% of total Billed Charges,4.36,62,,3.488,percent of total Billed Charges,62% of total Billed Charges,5.62,80,,4.496,percent of total Billed Charges,80% of Total Billed Charges,4.36,62,,3.488,percent of total Billed Charges,62% of total Billed Charges,4.36,62,,3.488,percent of total Billed Charges,62% of total Billed Charges,4.36,5.98,
NEPRO MXD BRY ARC INST LIQ 24X8 OZ,72270,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
NEPRO VAN ARC INST LIQ 24X8 OZ,72271,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72348,CDM,270,RC,,,Outpatient,,,53.69,37.583,,42.95,80,,34.36,percent of total Billed Charges,80% of Total Billed Charges,33.82,63,,27.056,percent of total Billed charges,63% of Total Billed Charges,33.29,62,,26.632,percent of total Billed Charges,62% of total BIlled charges,33.82,63,,27.056,percent of total Billed Charges,63% of total Billed Charges,45.64,85,,36.512,percent of total Billed Charges,85% of total Billed Charges,42.95,80,,34.36,percent of total Billed Charges,80% of total Billed Charges,33.29,62,,26.632,percent of total Billed Charges,62% of total Billed Charges,33.82,63,,27.056,percent of total Billed Charges,63% of total Billed Charges,33.29,62,,26.632,percent of total Billed Charges,62% of total Billed Charges,33.82,63,,27.056,percent of total billed charges,63% of total Billed Charges,33.29,62,,26.632,percent of total Billed Charges,62% of total Billed Charges,42.95,80,,34.36,percent of total Billed Charges,80% of Total Billed Charges,33.29,62,,26.632,percent of total Billed Charges,62% of total Billed Charges,33.29,62,,26.632,percent of total Billed Charges,62% of total Billed Charges,33.29,45.64,
BENEPROTEIN ORAL POWDER PACKET,72175,CDM,270,RC,,,Outpatient,,,77,53.9,,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,48.51,63,,38.808,percent of total Billed charges,63% of Total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total BIlled charges,48.51,63,,38.808,percent of total Billed Charges,63% of total Billed Charges,65.45,85,,52.36,percent of total Billed Charges,85% of total Billed Charges,61.6,80,,49.28,percent of total Billed Charges,80% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,48.51,63,,38.808,percent of total Billed Charges,63% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,48.51,63,,38.808,percent of total billed charges,63% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,47.74,65.45,
BENEPROTEIN ORAL POWDER PACKET,72174,CDM,270,RC,,,Outpatient,,,11.5,8.05,,9.2,80,,7.36,percent of total Billed Charges,80% of Total Billed Charges,7.25,63,,5.8,percent of total Billed charges,63% of Total Billed Charges,7.13,62,,5.704,percent of total Billed Charges,62% of total BIlled charges,7.25,63,,5.8,percent of total Billed Charges,63% of total Billed Charges,9.78,85,,7.824,percent of total Billed Charges,85% of total Billed Charges,9.2,80,,7.36,percent of total Billed Charges,80% of total Billed Charges,7.13,62,,5.704,percent of total Billed Charges,62% of total Billed Charges,7.25,63,,5.8,percent of total Billed Charges,63% of total Billed Charges,7.13,62,,5.704,percent of total Billed Charges,62% of total Billed Charges,7.25,63,,5.8,percent of total billed charges,63% of total Billed Charges,7.13,62,,5.704,percent of total Billed Charges,62% of total Billed Charges,9.2,80,,7.36,percent of total Billed Charges,80% of Total Billed Charges,7.13,62,,5.704,percent of total Billed Charges,62% of total Billed Charges,7.13,62,,5.704,percent of total Billed Charges,62% of total Billed Charges,7.13,9.78,
BENEPROTEIN ORAL POWDER PACKET,72063,CDM,270,RC,,,Outpatient,,,14.5,10.15,,11.6,80,,9.28,percent of total Billed Charges,80% of Total Billed Charges,9.14,63,,7.312,percent of total Billed charges,63% of Total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total BIlled charges,9.14,63,,7.312,percent of total Billed Charges,63% of total Billed Charges,12.33,85,,9.864,percent of total Billed Charges,85% of total Billed Charges,11.6,80,,9.28,percent of total Billed Charges,80% of total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total Billed Charges,9.14,63,,7.312,percent of total Billed Charges,63% of total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total Billed Charges,9.14,63,,7.312,percent of total billed charges,63% of total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total Billed Charges,11.6,80,,9.28,percent of total Billed Charges,80% of Total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total Billed Charges,8.99,12.33,
NOVASOURCE RENAL VANILLA LIQ 24X8OZ,72289,CDM,270,RC,,,Outpatient,,,10.43,7.301,,8.34,80,,6.672,percent of total Billed Charges,80% of Total Billed Charges,6.57,63,,5.256,percent of total Billed charges,63% of Total Billed Charges,6.47,62,,5.176,percent of total Billed Charges,62% of total BIlled charges,6.57,63,,5.256,percent of total Billed Charges,63% of total Billed Charges,8.87,85,,7.096,percent of total Billed Charges,85% of total Billed Charges,8.34,80,,6.672,percent of total Billed Charges,80% of total Billed Charges,6.47,62,,5.176,percent of total Billed Charges,62% of total Billed Charges,6.57,63,,5.256,percent of total Billed Charges,63% of total Billed Charges,6.47,62,,5.176,percent of total Billed Charges,62% of total Billed Charges,6.57,63,,5.256,percent of total billed charges,63% of total Billed Charges,6.47,62,,5.176,percent of total Billed Charges,62% of total Billed Charges,8.34,80,,6.672,percent of total Billed Charges,80% of Total Billed Charges,6.47,62,,5.176,percent of total Billed Charges,62% of total Billed Charges,6.47,62,,5.176,percent of total Billed Charges,62% of total Billed Charges,6.47,8.87,
BENEPROTEIN ORAL POWDER PACKET,71790,CDM,270,RC,,,Outpatient,,,38,26.6,,30.4,80,,24.32,percent of total Billed Charges,80% of Total Billed Charges,23.94,63,,19.152,percent of total Billed charges,63% of Total Billed Charges,23.56,62,,18.848,percent of total Billed Charges,62% of total BIlled charges,23.94,63,,19.152,percent of total Billed Charges,63% of total Billed Charges,32.3,85,,25.84,percent of total Billed Charges,85% of total Billed Charges,30.4,80,,24.32,percent of total Billed Charges,80% of total Billed Charges,23.56,62,,18.848,percent of total Billed Charges,62% of total Billed Charges,23.94,63,,19.152,percent of total Billed Charges,63% of total Billed Charges,23.56,62,,18.848,percent of total Billed Charges,62% of total Billed Charges,23.94,63,,19.152,percent of total billed charges,63% of total Billed Charges,23.56,62,,18.848,percent of total Billed Charges,62% of total Billed Charges,30.4,80,,24.32,percent of total Billed Charges,80% of Total Billed Charges,23.56,62,,18.848,percent of total Billed Charges,62% of total Billed Charges,23.56,62,,18.848,percent of total Billed Charges,62% of total Billed Charges,23.56,32.3,
BENEPROTEIN ORAL POWDER PACKET,72197,CDM,270,RC,,,Outpatient,,,17.5,12.25,,14,80,,11.2,percent of total Billed Charges,80% of Total Billed Charges,11.03,63,,8.824,percent of total Billed charges,63% of Total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total BIlled charges,11.03,63,,8.824,percent of total Billed Charges,63% of total Billed Charges,14.88,85,,11.904,percent of total Billed Charges,85% of total Billed Charges,14,80,,11.2,percent of total Billed Charges,80% of total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total Billed Charges,11.03,63,,8.824,percent of total Billed Charges,63% of total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total Billed Charges,11.03,63,,8.824,percent of total billed charges,63% of total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total Billed Charges,14,80,,11.2,percent of total Billed Charges,80% of Total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total Billed Charges,10.85,14.88,
BENEPROTEIN ORAL POWDER PACKET,70791,CDM,270,RC,,,Outpatient,,,25.08,17.556,,20.06,80,,16.048,percent of total Billed Charges,80% of Total Billed Charges,15.8,63,,12.64,percent of total Billed charges,63% of Total Billed Charges,15.55,62,,12.44,percent of total Billed Charges,62% of total BIlled charges,15.8,63,,12.64,percent of total Billed Charges,63% of total Billed Charges,21.32,85,,17.056,percent of total Billed Charges,85% of total Billed Charges,20.06,80,,16.048,percent of total Billed Charges,80% of total Billed Charges,15.55,62,,12.44,percent of total Billed Charges,62% of total Billed Charges,15.8,63,,12.64,percent of total Billed Charges,63% of total Billed Charges,15.55,62,,12.44,percent of total Billed Charges,62% of total Billed Charges,15.8,63,,12.64,percent of total billed charges,63% of total Billed Charges,15.55,62,,12.44,percent of total Billed Charges,62% of total Billed Charges,20.06,80,,16.048,percent of total Billed Charges,80% of Total Billed Charges,15.55,62,,12.44,percent of total Billed Charges,62% of total Billed Charges,15.55,62,,12.44,percent of total Billed Charges,62% of total Billed Charges,15.55,21.32,
BENEPROTEIN ORAL POWDER PACKET,72185,CDM,270,RC,,,Outpatient,,,23,16.1,,18.4,80,,14.72,percent of total Billed Charges,80% of Total Billed Charges,14.49,63,,11.592,percent of total Billed charges,63% of Total Billed Charges,14.26,62,,11.408,percent of total Billed Charges,62% of total BIlled charges,14.49,63,,11.592,percent of total Billed Charges,63% of total Billed Charges,19.55,85,,15.64,percent of total Billed Charges,85% of total Billed Charges,18.4,80,,14.72,percent of total Billed Charges,80% of total Billed Charges,14.26,62,,11.408,percent of total Billed Charges,62% of total Billed Charges,14.49,63,,11.592,percent of total Billed Charges,63% of total Billed Charges,14.26,62,,11.408,percent of total Billed Charges,62% of total Billed Charges,14.49,63,,11.592,percent of total billed charges,63% of total Billed Charges,14.26,62,,11.408,percent of total Billed Charges,62% of total Billed Charges,18.4,80,,14.72,percent of total Billed Charges,80% of Total Billed Charges,14.26,62,,11.408,percent of total Billed Charges,62% of total Billed Charges,14.26,62,,11.408,percent of total Billed Charges,62% of total Billed Charges,14.26,19.55,
BENEPROTEIN ORAL POWDER PACKET,70264,CDM,270,RC,,,Outpatient,,,58.14,40.698,,46.51,80,,37.208,percent of total Billed Charges,80% of Total Billed Charges,36.63,63,,29.304,percent of total Billed charges,63% of Total Billed Charges,36.05,62,,28.84,percent of total Billed Charges,62% of total BIlled charges,36.63,63,,29.304,percent of total Billed Charges,63% of total Billed Charges,49.42,85,,39.536,percent of total Billed Charges,85% of total Billed Charges,46.51,80,,37.208,percent of total Billed Charges,80% of total Billed Charges,36.05,62,,28.84,percent of total Billed Charges,62% of total Billed Charges,36.63,63,,29.304,percent of total Billed Charges,63% of total Billed Charges,36.05,62,,28.84,percent of total Billed Charges,62% of total Billed Charges,36.63,63,,29.304,percent of total billed charges,63% of total Billed Charges,36.05,62,,28.84,percent of total Billed Charges,62% of total Billed Charges,46.51,80,,37.208,percent of total Billed Charges,80% of Total Billed Charges,36.05,62,,28.84,percent of total Billed Charges,62% of total Billed Charges,36.05,62,,28.84,percent of total Billed Charges,62% of total Billed Charges,36.05,49.42,
BENEPROTEIN ORAL POWDER PACKET,70093,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72126,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72249,CDM,270,RC,,,Outpatient,,,26.74,18.718,,21.39,80,,17.112,percent of total Billed Charges,80% of Total Billed Charges,16.85,63,,13.48,percent of total Billed charges,63% of Total Billed Charges,16.58,62,,13.264,percent of total Billed Charges,62% of total BIlled charges,16.85,63,,13.48,percent of total Billed Charges,63% of total Billed Charges,22.73,85,,18.184,percent of total Billed Charges,85% of total Billed Charges,21.39,80,,17.112,percent of total Billed Charges,80% of total Billed Charges,16.58,62,,13.264,percent of total Billed Charges,62% of total Billed Charges,16.85,63,,13.48,percent of total Billed Charges,63% of total Billed Charges,16.58,62,,13.264,percent of total Billed Charges,62% of total Billed Charges,16.85,63,,13.48,percent of total billed charges,63% of total Billed Charges,16.58,62,,13.264,percent of total Billed Charges,62% of total Billed Charges,21.39,80,,17.112,percent of total Billed Charges,80% of Total Billed Charges,16.58,62,,13.264,percent of total Billed Charges,62% of total Billed Charges,16.58,62,,13.264,percent of total Billed Charges,62% of total Billed Charges,16.58,22.73,
BENEPROTEIN ORAL POWDER PACKET,72252,CDM,270,RC,,,Outpatient,,,62.97,44.079,,50.38,80,,40.304,percent of total Billed Charges,80% of Total Billed Charges,39.67,63,,31.736,percent of total Billed charges,63% of Total Billed Charges,39.04,62,,31.232,percent of total Billed Charges,62% of total BIlled charges,39.67,63,,31.736,percent of total Billed Charges,63% of total Billed Charges,53.52,85,,42.816,percent of total Billed Charges,85% of total Billed Charges,50.38,80,,40.304,percent of total Billed Charges,80% of total Billed Charges,39.04,62,,31.232,percent of total Billed Charges,62% of total Billed Charges,39.67,63,,31.736,percent of total Billed Charges,63% of total Billed Charges,39.04,62,,31.232,percent of total Billed Charges,62% of total Billed Charges,39.67,63,,31.736,percent of total billed charges,63% of total Billed Charges,39.04,62,,31.232,percent of total Billed Charges,62% of total Billed Charges,50.38,80,,40.304,percent of total Billed Charges,80% of Total Billed Charges,39.04,62,,31.232,percent of total Billed Charges,62% of total Billed Charges,39.04,62,,31.232,percent of total Billed Charges,62% of total Billed Charges,39.04,53.52,
BENEPROTEIN ORAL POWDER PACKET,72250,CDM,270,RC,,,Outpatient,,,36.79,25.753,,29.43,80,,23.544,percent of total Billed Charges,80% of Total Billed Charges,23.18,63,,18.544,percent of total Billed charges,63% of Total Billed Charges,22.81,62,,18.248,percent of total Billed Charges,62% of total BIlled charges,23.18,63,,18.544,percent of total Billed Charges,63% of total Billed Charges,31.27,85,,25.016,percent of total Billed Charges,85% of total Billed Charges,29.43,80,,23.544,percent of total Billed Charges,80% of total Billed Charges,22.81,62,,18.248,percent of total Billed Charges,62% of total Billed Charges,23.18,63,,18.544,percent of total Billed Charges,63% of total Billed Charges,22.81,62,,18.248,percent of total Billed Charges,62% of total Billed Charges,23.18,63,,18.544,percent of total billed charges,63% of total Billed Charges,22.81,62,,18.248,percent of total Billed Charges,62% of total Billed Charges,29.43,80,,23.544,percent of total Billed Charges,80% of Total Billed Charges,22.81,62,,18.248,percent of total Billed Charges,62% of total Billed Charges,22.81,62,,18.248,percent of total Billed Charges,62% of total Billed Charges,22.81,31.27,
BENEPROTEIN ORAL POWDER PACKET,72253,CDM,270,RC,,,Outpatient,,,72.84,50.988,,58.27,80,,46.616,percent of total Billed Charges,80% of Total Billed Charges,45.89,63,,36.712,percent of total Billed charges,63% of Total Billed Charges,45.16,62,,36.128,percent of total Billed Charges,62% of total BIlled charges,45.89,63,,36.712,percent of total Billed Charges,63% of total Billed Charges,61.91,85,,49.528,percent of total Billed Charges,85% of total Billed Charges,58.27,80,,46.616,percent of total Billed Charges,80% of total Billed Charges,45.16,62,,36.128,percent of total Billed Charges,62% of total Billed Charges,45.89,63,,36.712,percent of total Billed Charges,63% of total Billed Charges,45.16,62,,36.128,percent of total Billed Charges,62% of total Billed Charges,45.89,63,,36.712,percent of total billed charges,63% of total Billed Charges,45.16,62,,36.128,percent of total Billed Charges,62% of total Billed Charges,58.27,80,,46.616,percent of total Billed Charges,80% of Total Billed Charges,45.16,62,,36.128,percent of total Billed Charges,62% of total Billed Charges,45.16,62,,36.128,percent of total Billed Charges,62% of total Billed Charges,45.16,61.91,
BENEPROTEIN ORAL POWDER PACKET,72255,CDM,270,RC,,,Outpatient,,,85.44,59.808,,68.35,80,,54.68,percent of total Billed Charges,80% of Total Billed Charges,53.83,63,,43.064,percent of total Billed charges,63% of Total Billed Charges,52.97,62,,42.376,percent of total Billed Charges,62% of total BIlled charges,53.83,63,,43.064,percent of total Billed Charges,63% of total Billed Charges,72.62,85,,58.096,percent of total Billed Charges,85% of total Billed Charges,68.35,80,,54.68,percent of total Billed Charges,80% of total Billed Charges,52.97,62,,42.376,percent of total Billed Charges,62% of total Billed Charges,53.83,63,,43.064,percent of total Billed Charges,63% of total Billed Charges,52.97,62,,42.376,percent of total Billed Charges,62% of total Billed Charges,53.83,63,,43.064,percent of total billed charges,63% of total Billed Charges,52.97,62,,42.376,percent of total Billed Charges,62% of total Billed Charges,68.35,80,,54.68,percent of total Billed Charges,80% of Total Billed Charges,52.97,62,,42.376,percent of total Billed Charges,62% of total Billed Charges,52.97,62,,42.376,percent of total Billed Charges,62% of total Billed Charges,52.97,72.62,
BENEPROTEIN ORAL POWDER PACKET,72254,CDM,270,RC,,,Outpatient,,,105.95,74.165,,84.76,80,,67.808,percent of total Billed Charges,80% of Total Billed Charges,66.75,63,,53.4,percent of total Billed charges,63% of Total Billed Charges,65.69,62,,52.552,percent of total Billed Charges,62% of total BIlled charges,66.75,63,,53.4,percent of total Billed Charges,63% of total Billed Charges,90.06,85,,72.048,percent of total Billed Charges,85% of total Billed Charges,84.76,80,,67.808,percent of total Billed Charges,80% of total Billed Charges,65.69,62,,52.552,percent of total Billed Charges,62% of total Billed Charges,66.75,63,,53.4,percent of total Billed Charges,63% of total Billed Charges,65.69,62,,52.552,percent of total Billed Charges,62% of total Billed Charges,66.75,63,,53.4,percent of total billed charges,63% of total Billed Charges,65.69,62,,52.552,percent of total Billed Charges,62% of total Billed Charges,84.76,80,,67.808,percent of total Billed Charges,80% of Total Billed Charges,65.69,62,,52.552,percent of total Billed Charges,62% of total Billed Charges,65.69,62,,52.552,percent of total Billed Charges,62% of total Billed Charges,65.69,90.06,
BENEPROTEIN ORAL POWDER PACKET,72251,CDM,270,RC,,,Outpatient,,,27.72,19.404,,22.18,80,,17.744,percent of total Billed Charges,80% of Total Billed Charges,17.46,63,,13.968,percent of total Billed charges,63% of Total Billed Charges,17.19,62,,13.752,percent of total Billed Charges,62% of total BIlled charges,17.46,63,,13.968,percent of total Billed Charges,63% of total Billed Charges,23.56,85,,18.848,percent of total Billed Charges,85% of total Billed Charges,22.18,80,,17.744,percent of total Billed Charges,80% of total Billed Charges,17.19,62,,13.752,percent of total Billed Charges,62% of total Billed Charges,17.46,63,,13.968,percent of total Billed Charges,63% of total Billed Charges,17.19,62,,13.752,percent of total Billed Charges,62% of total Billed Charges,17.46,63,,13.968,percent of total billed charges,63% of total Billed Charges,17.19,62,,13.752,percent of total Billed Charges,62% of total Billed Charges,22.18,80,,17.744,percent of total Billed Charges,80% of Total Billed Charges,17.19,62,,13.752,percent of total Billed Charges,62% of total Billed Charges,17.19,62,,13.752,percent of total Billed Charges,62% of total Billed Charges,17.19,23.56,
BENEPROTEIN ORAL POWDER PACKET,72257,CDM,270,RC,,,Outpatient,,,92.56,64.792,,74.05,80,,59.24,percent of total Billed Charges,80% of Total Billed Charges,58.31,63,,46.648,percent of total Billed charges,63% of Total Billed Charges,57.39,62,,45.912,percent of total Billed Charges,62% of total BIlled charges,58.31,63,,46.648,percent of total Billed Charges,63% of total Billed Charges,78.68,85,,62.944,percent of total Billed Charges,85% of total Billed Charges,74.05,80,,59.24,percent of total Billed Charges,80% of total Billed Charges,57.39,62,,45.912,percent of total Billed Charges,62% of total Billed Charges,58.31,63,,46.648,percent of total Billed Charges,63% of total Billed Charges,57.39,62,,45.912,percent of total Billed Charges,62% of total Billed Charges,58.31,63,,46.648,percent of total billed charges,63% of total Billed Charges,57.39,62,,45.912,percent of total Billed Charges,62% of total Billed Charges,74.05,80,,59.24,percent of total Billed Charges,80% of Total Billed Charges,57.39,62,,45.912,percent of total Billed Charges,62% of total Billed Charges,57.39,62,,45.912,percent of total Billed Charges,62% of total Billed Charges,57.39,78.68,
BENEPROTEIN ORAL POWDER PACKET,72256,CDM,270,RC,,,Outpatient,,,119.73,83.811,,95.78,80,,76.624,percent of total Billed Charges,80% of Total Billed Charges,75.43,63,,60.344,percent of total Billed charges,63% of Total Billed Charges,74.23,62,,59.384,percent of total Billed Charges,62% of total BIlled charges,75.43,63,,60.344,percent of total Billed Charges,63% of total Billed Charges,101.77,85,,81.416,percent of total Billed Charges,85% of total Billed Charges,95.78,80,,76.624,percent of total Billed Charges,80% of total Billed Charges,74.23,62,,59.384,percent of total Billed Charges,62% of total Billed Charges,75.43,63,,60.344,percent of total Billed Charges,63% of total Billed Charges,74.23,62,,59.384,percent of total Billed Charges,62% of total Billed Charges,75.43,63,,60.344,percent of total billed charges,63% of total Billed Charges,74.23,62,,59.384,percent of total Billed Charges,62% of total Billed Charges,95.78,80,,76.624,percent of total Billed Charges,80% of Total Billed Charges,74.23,62,,59.384,percent of total Billed Charges,62% of total Billed Charges,74.23,62,,59.384,percent of total Billed Charges,62% of total Billed Charges,74.23,101.77,
BENEPROTEIN ORAL POWDER PACKET,70359,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70253,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71789,CDM,270,RC,,,Outpatient,,,74.66,52.262,,59.73,80,,47.784,percent of total Billed Charges,80% of Total Billed Charges,47.04,63,,37.632,percent of total Billed charges,63% of Total Billed Charges,46.29,62,,37.032,percent of total Billed Charges,62% of total BIlled charges,47.04,63,,37.632,percent of total Billed Charges,63% of total Billed Charges,63.46,85,,50.768,percent of total Billed Charges,85% of total Billed Charges,59.73,80,,47.784,percent of total Billed Charges,80% of total Billed Charges,46.29,62,,37.032,percent of total Billed Charges,62% of total Billed Charges,47.04,63,,37.632,percent of total Billed Charges,63% of total Billed Charges,46.29,62,,37.032,percent of total Billed Charges,62% of total Billed Charges,47.04,63,,37.632,percent of total billed charges,63% of total Billed Charges,46.29,62,,37.032,percent of total Billed Charges,62% of total Billed Charges,59.73,80,,47.784,percent of total Billed Charges,80% of Total Billed Charges,46.29,62,,37.032,percent of total Billed Charges,62% of total Billed Charges,46.29,62,,37.032,percent of total Billed Charges,62% of total Billed Charges,46.29,63.46,
BENEPROTEIN ORAL POWDER PACKET,72127,CDM,270,RC,,,Outpatient,,,34.5,24.15,,27.6,80,,22.08,percent of total Billed Charges,80% of Total Billed Charges,21.74,63,,17.392,percent of total Billed charges,63% of Total Billed Charges,21.39,62,,17.112,percent of total Billed Charges,62% of total BIlled charges,21.74,63,,17.392,percent of total Billed Charges,63% of total Billed Charges,29.33,85,,23.464,percent of total Billed Charges,85% of total Billed Charges,27.6,80,,22.08,percent of total Billed Charges,80% of total Billed Charges,21.39,62,,17.112,percent of total Billed Charges,62% of total Billed Charges,21.74,63,,17.392,percent of total Billed Charges,63% of total Billed Charges,21.39,62,,17.112,percent of total Billed Charges,62% of total Billed Charges,21.74,63,,17.392,percent of total billed charges,63% of total Billed Charges,21.39,62,,17.112,percent of total Billed Charges,62% of total Billed Charges,27.6,80,,22.08,percent of total Billed Charges,80% of Total Billed Charges,21.39,62,,17.112,percent of total Billed Charges,62% of total Billed Charges,21.39,62,,17.112,percent of total Billed Charges,62% of total Billed Charges,21.39,29.33,
BENEPROTEIN ORAL POWDER PACKET,72188,CDM,270,RC,,,Outpatient,,,13.5,9.45,,10.8,80,,8.64,percent of total Billed Charges,80% of Total Billed Charges,8.51,63,,6.808,percent of total Billed charges,63% of Total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total BIlled charges,8.51,63,,6.808,percent of total Billed Charges,63% of total Billed Charges,11.48,85,,9.184,percent of total Billed Charges,85% of total Billed Charges,10.8,80,,8.64,percent of total Billed Charges,80% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.51,63,,6.808,percent of total Billed Charges,63% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.51,63,,6.808,percent of total billed charges,63% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,10.8,80,,8.64,percent of total Billed Charges,80% of Total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.37,11.48,
BENEPROTEIN ORAL POWDER PACKET,72187,CDM,270,RC,,,Outpatient,,,13,9.1,,10.4,80,,8.32,percent of total Billed Charges,80% of Total Billed Charges,8.19,63,,6.552,percent of total Billed charges,63% of Total Billed Charges,8.06,62,,6.448,percent of total Billed Charges,62% of total BIlled charges,8.19,63,,6.552,percent of total Billed Charges,63% of total Billed Charges,11.05,85,,8.84,percent of total Billed Charges,85% of total Billed Charges,10.4,80,,8.32,percent of total Billed Charges,80% of total Billed Charges,8.06,62,,6.448,percent of total Billed Charges,62% of total Billed Charges,8.19,63,,6.552,percent of total Billed Charges,63% of total Billed Charges,8.06,62,,6.448,percent of total Billed Charges,62% of total Billed Charges,8.19,63,,6.552,percent of total billed charges,63% of total Billed Charges,8.06,62,,6.448,percent of total Billed Charges,62% of total Billed Charges,10.4,80,,8.32,percent of total Billed Charges,80% of Total Billed Charges,8.06,62,,6.448,percent of total Billed Charges,62% of total Billed Charges,8.06,62,,6.448,percent of total Billed Charges,62% of total Billed Charges,8.06,11.05,
BENEPROTEIN ORAL POWDER PACKET,71031,CDM,270,RC,,,Outpatient,,,57.5,40.25,,46,80,,36.8,percent of total Billed Charges,80% of Total Billed Charges,36.23,63,,28.984,percent of total Billed charges,63% of Total Billed Charges,35.65,62,,28.52,percent of total Billed Charges,62% of total BIlled charges,36.23,63,,28.984,percent of total Billed Charges,63% of total Billed Charges,48.88,85,,39.104,percent of total Billed Charges,85% of total Billed Charges,46,80,,36.8,percent of total Billed Charges,80% of total Billed Charges,35.65,62,,28.52,percent of total Billed Charges,62% of total Billed Charges,36.23,63,,28.984,percent of total Billed Charges,63% of total Billed Charges,35.65,62,,28.52,percent of total Billed Charges,62% of total Billed Charges,36.23,63,,28.984,percent of total billed charges,63% of total Billed Charges,35.65,62,,28.52,percent of total Billed Charges,62% of total Billed Charges,46,80,,36.8,percent of total Billed Charges,80% of Total Billed Charges,35.65,62,,28.52,percent of total Billed Charges,62% of total Billed Charges,35.65,62,,28.52,percent of total Billed Charges,62% of total Billed Charges,35.65,48.88,
BENEPROTEIN ORAL POWDER PACKET,70091,CDM,270,RC,,,Outpatient,,,5.95,4.165,,4.76,80,,3.808,percent of total Billed Charges,80% of Total Billed Charges,3.75,63,,3,percent of total Billed charges,63% of Total Billed Charges,3.69,62,,2.952,percent of total Billed Charges,62% of total BIlled charges,3.75,63,,3,percent of total Billed Charges,63% of total Billed Charges,5.06,85,,4.048,percent of total Billed Charges,85% of total Billed Charges,4.76,80,,3.808,percent of total Billed Charges,80% of total Billed Charges,3.69,62,,2.952,percent of total Billed Charges,62% of total Billed Charges,3.75,63,,3,percent of total Billed Charges,63% of total Billed Charges,3.69,62,,2.952,percent of total Billed Charges,62% of total Billed Charges,3.75,63,,3,percent of total billed charges,63% of total Billed Charges,3.69,62,,2.952,percent of total Billed Charges,62% of total Billed Charges,4.76,80,,3.808,percent of total Billed Charges,80% of Total Billed Charges,3.69,62,,2.952,percent of total Billed Charges,62% of total Billed Charges,3.69,62,,2.952,percent of total Billed Charges,62% of total Billed Charges,3.69,5.06,
BENEPROTEIN ORAL POWDER PACKET,72231,CDM,270,RC,,,Outpatient,,,58.42,40.894,,46.74,80,,37.392,percent of total Billed Charges,80% of Total Billed Charges,36.8,63,,29.44,percent of total Billed charges,63% of Total Billed Charges,36.22,62,,28.976,percent of total Billed Charges,62% of total BIlled charges,36.8,63,,29.44,percent of total Billed Charges,63% of total Billed Charges,49.66,85,,39.728,percent of total Billed Charges,85% of total Billed Charges,46.74,80,,37.392,percent of total Billed Charges,80% of total Billed Charges,36.22,62,,28.976,percent of total Billed Charges,62% of total Billed Charges,36.8,63,,29.44,percent of total Billed Charges,63% of total Billed Charges,36.22,62,,28.976,percent of total Billed Charges,62% of total Billed Charges,36.8,63,,29.44,percent of total billed charges,63% of total Billed Charges,36.22,62,,28.976,percent of total Billed Charges,62% of total Billed Charges,46.74,80,,37.392,percent of total Billed Charges,80% of Total Billed Charges,36.22,62,,28.976,percent of total Billed Charges,62% of total Billed Charges,36.22,62,,28.976,percent of total Billed Charges,62% of total Billed Charges,36.22,49.66,
BENEPROTEIN ORAL POWDER PACKET,70553,CDM,270,RC,,,Outpatient,,,21.35,14.945,,17.08,80,,13.664,percent of total Billed Charges,80% of Total Billed Charges,13.45,63,,10.76,percent of total Billed charges,63% of Total Billed Charges,13.24,62,,10.592,percent of total Billed Charges,62% of total BIlled charges,13.45,63,,10.76,percent of total Billed Charges,63% of total Billed Charges,18.15,85,,14.52,percent of total Billed Charges,85% of total Billed Charges,17.08,80,,13.664,percent of total Billed Charges,80% of total Billed Charges,13.24,62,,10.592,percent of total Billed Charges,62% of total Billed Charges,13.45,63,,10.76,percent of total Billed Charges,63% of total Billed Charges,13.24,62,,10.592,percent of total Billed Charges,62% of total Billed Charges,13.45,63,,10.76,percent of total billed charges,63% of total Billed Charges,13.24,62,,10.592,percent of total Billed Charges,62% of total Billed Charges,17.08,80,,13.664,percent of total Billed Charges,80% of Total Billed Charges,13.24,62,,10.592,percent of total Billed Charges,62% of total Billed Charges,13.24,62,,10.592,percent of total Billed Charges,62% of total Billed Charges,13.24,18.15,
BENEPROTEIN ORAL POWDER PACKET,71764,CDM,270,RC,,,Outpatient,,,28,19.6,,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,17.64,63,,14.112,percent of total Billed charges,63% of Total Billed Charges,17.36,62,,13.888,percent of total Billed Charges,62% of total BIlled charges,17.64,63,,14.112,percent of total Billed Charges,63% of total Billed Charges,23.8,85,,19.04,percent of total Billed Charges,85% of total Billed Charges,22.4,80,,17.92,percent of total Billed Charges,80% of total Billed Charges,17.36,62,,13.888,percent of total Billed Charges,62% of total Billed Charges,17.64,63,,14.112,percent of total Billed Charges,63% of total Billed Charges,17.36,62,,13.888,percent of total Billed Charges,62% of total Billed Charges,17.64,63,,14.112,percent of total billed charges,63% of total Billed Charges,17.36,62,,13.888,percent of total Billed Charges,62% of total Billed Charges,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,17.36,62,,13.888,percent of total Billed Charges,62% of total Billed Charges,17.36,62,,13.888,percent of total Billed Charges,62% of total Billed Charges,17.36,23.8,
BENEPROTEIN ORAL POWDER PACKET,70885,CDM,270,RC,,,Outpatient,,,15.37,10.759,,12.3,80,,9.84,percent of total Billed Charges,80% of Total Billed Charges,9.68,63,,7.744,percent of total Billed charges,63% of Total Billed Charges,9.53,62,,7.624,percent of total Billed Charges,62% of total BIlled charges,9.68,63,,7.744,percent of total Billed Charges,63% of total Billed Charges,13.06,85,,10.448,percent of total Billed Charges,85% of total Billed Charges,12.3,80,,9.84,percent of total Billed Charges,80% of total Billed Charges,9.53,62,,7.624,percent of total Billed Charges,62% of total Billed Charges,9.68,63,,7.744,percent of total Billed Charges,63% of total Billed Charges,9.53,62,,7.624,percent of total Billed Charges,62% of total Billed Charges,9.68,63,,7.744,percent of total billed charges,63% of total Billed Charges,9.53,62,,7.624,percent of total Billed Charges,62% of total Billed Charges,12.3,80,,9.84,percent of total Billed Charges,80% of Total Billed Charges,9.53,62,,7.624,percent of total Billed Charges,62% of total Billed Charges,9.53,62,,7.624,percent of total Billed Charges,62% of total Billed Charges,9.53,13.06,
BENEPROTEIN ORAL POWDER PACKET,70099,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72075,CDM,270,RC,,,Outpatient,,,12.46,8.722,,9.97,80,,7.976,percent of total Billed Charges,80% of Total Billed Charges,7.85,63,,6.28,percent of total Billed charges,63% of Total Billed Charges,7.73,62,,6.184,percent of total Billed Charges,62% of total BIlled charges,7.85,63,,6.28,percent of total Billed Charges,63% of total Billed Charges,10.59,85,,8.472,percent of total Billed Charges,85% of total Billed Charges,9.97,80,,7.976,percent of total Billed Charges,80% of total Billed Charges,7.73,62,,6.184,percent of total Billed Charges,62% of total Billed Charges,7.85,63,,6.28,percent of total Billed Charges,63% of total Billed Charges,7.73,62,,6.184,percent of total Billed Charges,62% of total Billed Charges,7.85,63,,6.28,percent of total billed charges,63% of total Billed Charges,7.73,62,,6.184,percent of total Billed Charges,62% of total Billed Charges,9.97,80,,7.976,percent of total Billed Charges,80% of Total Billed Charges,7.73,62,,6.184,percent of total Billed Charges,62% of total Billed Charges,7.73,62,,6.184,percent of total Billed Charges,62% of total Billed Charges,7.73,10.59,
BENEPROTEIN ORAL POWDER PACKET,72049,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72046,CDM,270,RC,,,Outpatient,,,8.58,6.006,,6.86,80,,5.488,percent of total Billed Charges,80% of Total Billed Charges,5.41,63,,4.328,percent of total Billed charges,63% of Total Billed Charges,5.32,62,,4.256,percent of total Billed Charges,62% of total BIlled charges,5.41,63,,4.328,percent of total Billed Charges,63% of total Billed Charges,7.29,85,,5.832,percent of total Billed Charges,85% of total Billed Charges,6.86,80,,5.488,percent of total Billed Charges,80% of total Billed Charges,5.32,62,,4.256,percent of total Billed Charges,62% of total Billed Charges,5.41,63,,4.328,percent of total Billed Charges,63% of total Billed Charges,5.32,62,,4.256,percent of total Billed Charges,62% of total Billed Charges,5.41,63,,4.328,percent of total billed charges,63% of total Billed Charges,5.32,62,,4.256,percent of total Billed Charges,62% of total Billed Charges,6.86,80,,5.488,percent of total Billed Charges,80% of Total Billed Charges,5.32,62,,4.256,percent of total Billed Charges,62% of total Billed Charges,5.32,62,,4.256,percent of total Billed Charges,62% of total Billed Charges,5.32,7.29,
PIVOT 1.5 CAL ARC INST LIQ 24X8 OZ,72274,CDM,270,RC,,,Outpatient,,,5.5,3.85,,4.4,80,,3.52,percent of total Billed Charges,80% of Total Billed Charges,3.47,63,,2.776,percent of total Billed charges,63% of Total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total BIlled charges,3.47,63,,2.776,percent of total Billed Charges,63% of total Billed Charges,4.68,85,,3.744,percent of total Billed Charges,85% of total Billed Charges,4.4,80,,3.52,percent of total Billed Charges,80% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.47,63,,2.776,percent of total Billed Charges,63% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.47,63,,2.776,percent of total billed charges,63% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,4.4,80,,3.52,percent of total Billed Charges,80% of Total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.41,4.68,
BENEPROTEIN ORAL POWDER PACKET,70522,CDM,270,RC,,,Outpatient,,,91.5,64.05,,73.2,80,,58.56,percent of total Billed Charges,80% of Total Billed Charges,57.65,63,,46.12,percent of total Billed charges,63% of Total Billed Charges,56.73,62,,45.384,percent of total Billed Charges,62% of total BIlled charges,57.65,63,,46.12,percent of total Billed Charges,63% of total Billed Charges,77.78,85,,62.224,percent of total Billed Charges,85% of total Billed Charges,73.2,80,,58.56,percent of total Billed Charges,80% of total Billed Charges,56.73,62,,45.384,percent of total Billed Charges,62% of total Billed Charges,57.65,63,,46.12,percent of total Billed Charges,63% of total Billed Charges,56.73,62,,45.384,percent of total Billed Charges,62% of total Billed Charges,57.65,63,,46.12,percent of total billed charges,63% of total Billed Charges,56.73,62,,45.384,percent of total Billed Charges,62% of total Billed Charges,73.2,80,,58.56,percent of total Billed Charges,80% of Total Billed Charges,56.73,62,,45.384,percent of total Billed Charges,62% of total Billed Charges,56.73,62,,45.384,percent of total Billed Charges,62% of total Billed Charges,56.73,77.78,
BENEPROTEIN ORAL POWDER PACKET,70254,CDM,270,RC,,,Outpatient,,,38.5,26.95,,30.8,80,,24.64,percent of total Billed Charges,80% of Total Billed Charges,24.26,63,,19.408,percent of total Billed charges,63% of Total Billed Charges,23.87,62,,19.096,percent of total Billed Charges,62% of total BIlled charges,24.26,63,,19.408,percent of total Billed Charges,63% of total Billed Charges,32.73,85,,26.184,percent of total Billed Charges,85% of total Billed Charges,30.8,80,,24.64,percent of total Billed Charges,80% of total Billed Charges,23.87,62,,19.096,percent of total Billed Charges,62% of total Billed Charges,24.26,63,,19.408,percent of total Billed Charges,63% of total Billed Charges,23.87,62,,19.096,percent of total Billed Charges,62% of total Billed Charges,24.26,63,,19.408,percent of total billed charges,63% of total Billed Charges,23.87,62,,19.096,percent of total Billed Charges,62% of total Billed Charges,30.8,80,,24.64,percent of total Billed Charges,80% of Total Billed Charges,23.87,62,,19.096,percent of total Billed Charges,62% of total Billed Charges,23.87,62,,19.096,percent of total Billed Charges,62% of total Billed Charges,23.87,32.73,
BENEPROTEIN ORAL POWDER PACKET,70255,CDM,270,RC,,,Outpatient,,,38.5,26.95,,30.8,80,,24.64,percent of total Billed Charges,80% of Total Billed Charges,24.26,63,,19.408,percent of total Billed charges,63% of Total Billed Charges,23.87,62,,19.096,percent of total Billed Charges,62% of total BIlled charges,24.26,63,,19.408,percent of total Billed Charges,63% of total Billed Charges,32.73,85,,26.184,percent of total Billed Charges,85% of total Billed Charges,30.8,80,,24.64,percent of total Billed Charges,80% of total Billed Charges,23.87,62,,19.096,percent of total Billed Charges,62% of total Billed Charges,24.26,63,,19.408,percent of total Billed Charges,63% of total Billed Charges,23.87,62,,19.096,percent of total Billed Charges,62% of total Billed Charges,24.26,63,,19.408,percent of total billed charges,63% of total Billed Charges,23.87,62,,19.096,percent of total Billed Charges,62% of total Billed Charges,30.8,80,,24.64,percent of total Billed Charges,80% of Total Billed Charges,23.87,62,,19.096,percent of total Billed Charges,62% of total Billed Charges,23.87,62,,19.096,percent of total Billed Charges,62% of total Billed Charges,23.87,32.73,
BENEPROTEIN ORAL POWDER PACKET,150070,CDM,270,RC,,,Outpatient,,,17.5,12.25,,14,80,,11.2,percent of total Billed Charges,80% of Total Billed Charges,11.03,63,,8.824,percent of total Billed charges,63% of Total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total BIlled charges,11.03,63,,8.824,percent of total Billed Charges,63% of total Billed Charges,14.88,85,,11.904,percent of total Billed Charges,85% of total Billed Charges,14,80,,11.2,percent of total Billed Charges,80% of total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total Billed Charges,11.03,63,,8.824,percent of total Billed Charges,63% of total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total Billed Charges,11.03,63,,8.824,percent of total billed charges,63% of total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total Billed Charges,14,80,,11.2,percent of total Billed Charges,80% of Total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total Billed Charges,10.85,62,,8.68,percent of total Billed Charges,62% of total Billed Charges,10.85,14.88,
BENEPROTEIN ORAL POWDER PACKET,150037,CDM,270,RC,,,Outpatient,,,9.35,6.545,,7.48,80,,5.984,percent of total Billed Charges,80% of Total Billed Charges,5.89,63,,4.712,percent of total Billed charges,63% of Total Billed Charges,5.8,62,,4.64,percent of total Billed Charges,62% of total BIlled charges,5.89,63,,4.712,percent of total Billed Charges,63% of total Billed Charges,7.95,85,,6.36,percent of total Billed Charges,85% of total Billed Charges,7.48,80,,5.984,percent of total Billed Charges,80% of total Billed Charges,5.8,62,,4.64,percent of total Billed Charges,62% of total Billed Charges,5.89,63,,4.712,percent of total Billed Charges,63% of total Billed Charges,5.8,62,,4.64,percent of total Billed Charges,62% of total Billed Charges,5.89,63,,4.712,percent of total billed charges,63% of total Billed Charges,5.8,62,,4.64,percent of total Billed Charges,62% of total Billed Charges,7.48,80,,5.984,percent of total Billed Charges,80% of Total Billed Charges,5.8,62,,4.64,percent of total Billed Charges,62% of total Billed Charges,5.8,62,,4.64,percent of total Billed Charges,62% of total Billed Charges,5.8,7.95,
BENEPROTEIN ORAL POWDER PACKET,70778,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70786,CDM,270,RC,,,Outpatient,,,8.72,6.104,,6.98,80,,5.584,percent of total Billed Charges,80% of Total Billed Charges,5.49,63,,4.392,percent of total Billed charges,63% of Total Billed Charges,5.41,62,,4.328,percent of total Billed Charges,62% of total BIlled charges,5.49,63,,4.392,percent of total Billed Charges,63% of total Billed Charges,7.41,85,,5.928,percent of total Billed Charges,85% of total Billed Charges,6.98,80,,5.584,percent of total Billed Charges,80% of total Billed Charges,5.41,62,,4.328,percent of total Billed Charges,62% of total Billed Charges,5.49,63,,4.392,percent of total Billed Charges,63% of total Billed Charges,5.41,62,,4.328,percent of total Billed Charges,62% of total Billed Charges,5.49,63,,4.392,percent of total billed charges,63% of total Billed Charges,5.41,62,,4.328,percent of total Billed Charges,62% of total Billed Charges,6.98,80,,5.584,percent of total Billed Charges,80% of Total Billed Charges,5.41,62,,4.328,percent of total Billed Charges,62% of total Billed Charges,5.41,62,,4.328,percent of total Billed Charges,62% of total Billed Charges,5.41,7.41,
PROTEINEX-18 LIQUID UD BLACK CHERRY 1OZ,72268,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70787,CDM,270,RC,,,Outpatient,,,18.03,12.621,,14.42,80,,11.536,percent of total Billed Charges,80% of Total Billed Charges,11.36,63,,9.088,percent of total Billed charges,63% of Total Billed Charges,11.18,62,,8.944,percent of total Billed Charges,62% of total BIlled charges,11.36,63,,9.088,percent of total Billed Charges,63% of total Billed Charges,15.33,85,,12.264,percent of total Billed Charges,85% of total Billed Charges,14.42,80,,11.536,percent of total Billed Charges,80% of total Billed Charges,11.18,62,,8.944,percent of total Billed Charges,62% of total Billed Charges,11.36,63,,9.088,percent of total Billed Charges,63% of total Billed Charges,11.18,62,,8.944,percent of total Billed Charges,62% of total Billed Charges,11.36,63,,9.088,percent of total billed charges,63% of total Billed Charges,11.18,62,,8.944,percent of total Billed Charges,62% of total Billed Charges,14.42,80,,11.536,percent of total Billed Charges,80% of Total Billed Charges,11.18,62,,8.944,percent of total Billed Charges,62% of total Billed Charges,11.18,62,,8.944,percent of total Billed Charges,62% of total Billed Charges,11.18,15.33,
BENEPROTEIN ORAL POWDER PACKET,72178,CDM,270,RC,,,Outpatient,,,9.5,6.65,,7.6,80,,6.08,percent of total Billed Charges,80% of Total Billed Charges,5.99,63,,4.792,percent of total Billed charges,63% of Total Billed Charges,5.89,62,,4.712,percent of total Billed Charges,62% of total BIlled charges,5.99,63,,4.792,percent of total Billed Charges,63% of total Billed Charges,8.08,85,,6.464,percent of total Billed Charges,85% of total Billed Charges,7.6,80,,6.08,percent of total Billed Charges,80% of total Billed Charges,5.89,62,,4.712,percent of total Billed Charges,62% of total Billed Charges,5.99,63,,4.792,percent of total Billed Charges,63% of total Billed Charges,5.89,62,,4.712,percent of total Billed Charges,62% of total Billed Charges,5.99,63,,4.792,percent of total billed charges,63% of total Billed Charges,5.89,62,,4.712,percent of total Billed Charges,62% of total Billed Charges,7.6,80,,6.08,percent of total Billed Charges,80% of Total Billed Charges,5.89,62,,4.712,percent of total Billed Charges,62% of total Billed Charges,5.89,62,,4.712,percent of total Billed Charges,62% of total Billed Charges,5.89,8.08,
BENEPROTEIN ORAL POWDER PACKET,70126,CDM,270,RC,,,Outpatient,,,7.53,5.271,,6.02,80,,4.816,percent of total Billed Charges,80% of Total Billed Charges,4.74,63,,3.792,percent of total Billed charges,63% of Total Billed Charges,4.67,62,,3.736,percent of total Billed Charges,62% of total BIlled charges,4.74,63,,3.792,percent of total Billed Charges,63% of total Billed Charges,6.4,85,,5.12,percent of total Billed Charges,85% of total Billed Charges,6.02,80,,4.816,percent of total Billed Charges,80% of total Billed Charges,4.67,62,,3.736,percent of total Billed Charges,62% of total Billed Charges,4.74,63,,3.792,percent of total Billed Charges,63% of total Billed Charges,4.67,62,,3.736,percent of total Billed Charges,62% of total Billed Charges,4.74,63,,3.792,percent of total billed charges,63% of total Billed Charges,4.67,62,,3.736,percent of total Billed Charges,62% of total Billed Charges,6.02,80,,4.816,percent of total Billed Charges,80% of Total Billed Charges,4.67,62,,3.736,percent of total Billed Charges,62% of total Billed Charges,4.67,62,,3.736,percent of total Billed Charges,62% of total Billed Charges,4.67,6.4,
BENEPROTEIN ORAL POWDER PACKET,70358,CDM,270,RC,,,Outpatient,,,272.7,190.89,,218.16,80,,174.528,percent of total Billed Charges,80% of Total Billed Charges,171.8,63,,137.44,percent of total Billed charges,63% of Total Billed Charges,169.07,62,,135.256,percent of total Billed Charges,62% of total BIlled charges,171.8,63,,137.44,percent of total Billed Charges,63% of total Billed Charges,231.8,85,,185.44,percent of total Billed Charges,85% of total Billed Charges,218.16,80,,174.528,percent of total Billed Charges,80% of total Billed Charges,169.07,62,,135.256,percent of total Billed Charges,62% of total Billed Charges,171.8,63,,137.44,percent of total Billed Charges,63% of total Billed Charges,169.07,62,,135.256,percent of total Billed Charges,62% of total Billed Charges,171.8,63,,137.44,percent of total billed charges,63% of total Billed Charges,169.07,62,,135.256,percent of total Billed Charges,62% of total Billed Charges,218.16,80,,174.528,percent of total Billed Charges,80% of Total Billed Charges,169.07,62,,135.256,percent of total Billed Charges,62% of total Billed Charges,169.07,62,,135.256,percent of total Billed Charges,62% of total Billed Charges,169.07,231.8,
BENEPROTEIN ORAL POWDER PACKET,71792,CDM,270,RC,,,Outpatient,,,22.61,15.827,,18.09,80,,14.472,percent of total Billed Charges,80% of Total Billed Charges,14.24,63,,11.392,percent of total Billed charges,63% of Total Billed Charges,14.02,62,,11.216,percent of total Billed Charges,62% of total BIlled charges,14.24,63,,11.392,percent of total Billed Charges,63% of total Billed Charges,19.22,85,,15.376,percent of total Billed Charges,85% of total Billed Charges,18.09,80,,14.472,percent of total Billed Charges,80% of total Billed Charges,14.02,62,,11.216,percent of total Billed Charges,62% of total Billed Charges,14.24,63,,11.392,percent of total Billed Charges,63% of total Billed Charges,14.02,62,,11.216,percent of total Billed Charges,62% of total Billed Charges,14.24,63,,11.392,percent of total billed charges,63% of total Billed Charges,14.02,62,,11.216,percent of total Billed Charges,62% of total Billed Charges,18.09,80,,14.472,percent of total Billed Charges,80% of Total Billed Charges,14.02,62,,11.216,percent of total Billed Charges,62% of total Billed Charges,14.02,62,,11.216,percent of total Billed Charges,62% of total Billed Charges,14.02,19.22,
BENEPROTEIN ORAL POWDER PACKET,72245,CDM,270,RC,,,Outpatient,,,303.01,212.107,,242.41,80,,193.928,percent of total Billed Charges,80% of Total Billed Charges,190.9,63,,152.72,percent of total Billed charges,63% of Total Billed Charges,187.87,62,,150.296,percent of total Billed Charges,62% of total BIlled charges,190.9,63,,152.72,percent of total Billed Charges,63% of total Billed Charges,257.56,85,,206.048,percent of total Billed Charges,85% of total Billed Charges,242.41,80,,193.928,percent of total Billed Charges,80% of total Billed Charges,187.87,62,,150.296,percent of total Billed Charges,62% of total Billed Charges,190.9,63,,152.72,percent of total Billed Charges,63% of total Billed Charges,187.87,62,,150.296,percent of total Billed Charges,62% of total Billed Charges,190.9,63,,152.72,percent of total billed charges,63% of total Billed Charges,187.87,62,,150.296,percent of total Billed Charges,62% of total Billed Charges,242.41,80,,193.928,percent of total Billed Charges,80% of Total Billed Charges,187.87,62,,150.296,percent of total Billed Charges,62% of total Billed Charges,187.87,62,,150.296,percent of total Billed Charges,62% of total Billed Charges,187.87,257.56,
REAL FOOD BLND BF/PT/SPN LIQ 12X9.4OZ DS,72300,CDM,270,RC,,,Outpatient,,,17.04,11.928,,13.63,80,,10.904,percent of total Billed Charges,80% of Total Billed Charges,10.74,63,,8.592,percent of total Billed charges,63% of Total Billed Charges,10.56,62,,8.448,percent of total Billed Charges,62% of total BIlled charges,10.74,63,,8.592,percent of total Billed Charges,63% of total Billed Charges,14.48,85,,11.584,percent of total Billed Charges,85% of total Billed Charges,13.63,80,,10.904,percent of total Billed Charges,80% of total Billed Charges,10.56,62,,8.448,percent of total Billed Charges,62% of total Billed Charges,10.74,63,,8.592,percent of total Billed Charges,63% of total Billed Charges,10.56,62,,8.448,percent of total Billed Charges,62% of total Billed Charges,10.74,63,,8.592,percent of total billed charges,63% of total Billed Charges,10.56,62,,8.448,percent of total Billed Charges,62% of total Billed Charges,13.63,80,,10.904,percent of total Billed Charges,80% of Total Billed Charges,10.56,62,,8.448,percent of total Billed Charges,62% of total Billed Charges,10.56,62,,8.448,percent of total Billed Charges,62% of total Billed Charges,10.56,14.48,
REAL FOOD BLND EG APL OT LIQ 12X9.4OZ DS,72301,CDM,270,RC,,,Outpatient,,,17.04,11.928,,13.63,80,,10.904,percent of total Billed Charges,80% of Total Billed Charges,10.74,63,,8.592,percent of total Billed charges,63% of Total Billed Charges,10.56,62,,8.448,percent of total Billed Charges,62% of total BIlled charges,10.74,63,,8.592,percent of total Billed Charges,63% of total Billed Charges,14.48,85,,11.584,percent of total Billed Charges,85% of total Billed Charges,13.63,80,,10.904,percent of total Billed Charges,80% of total Billed Charges,10.56,62,,8.448,percent of total Billed Charges,62% of total Billed Charges,10.74,63,,8.592,percent of total Billed Charges,63% of total Billed Charges,10.56,62,,8.448,percent of total Billed Charges,62% of total Billed Charges,10.74,63,,8.592,percent of total billed charges,63% of total Billed Charges,10.56,62,,8.448,percent of total Billed Charges,62% of total Billed Charges,13.63,80,,10.904,percent of total Billed Charges,80% of Total Billed Charges,10.56,62,,8.448,percent of total Billed Charges,62% of total Billed Charges,10.56,62,,8.448,percent of total Billed Charges,62% of total Billed Charges,10.56,14.48,
REAL FOOD BLND TR/SWP/PE LIQ 12X9.4OZ DS,72302,CDM,270,RC,,,Outpatient,,,15.15,10.605,,12.12,80,,9.696,percent of total Billed Charges,80% of Total Billed Charges,9.54,63,,7.632,percent of total Billed charges,63% of Total Billed Charges,9.39,62,,7.512,percent of total Billed Charges,62% of total BIlled charges,9.54,63,,7.632,percent of total Billed Charges,63% of total Billed Charges,12.88,85,,10.304,percent of total Billed Charges,85% of total Billed Charges,12.12,80,,9.696,percent of total Billed Charges,80% of total Billed Charges,9.39,62,,7.512,percent of total Billed Charges,62% of total Billed Charges,9.54,63,,7.632,percent of total Billed Charges,63% of total Billed Charges,9.39,62,,7.512,percent of total Billed Charges,62% of total Billed Charges,9.54,63,,7.632,percent of total billed charges,63% of total Billed Charges,9.39,62,,7.512,percent of total Billed Charges,62% of total Billed Charges,12.12,80,,9.696,percent of total Billed Charges,80% of Total Billed Charges,9.39,62,,7.512,percent of total Billed Charges,62% of total Billed Charges,9.39,62,,7.512,percent of total Billed Charges,62% of total Billed Charges,9.39,12.88,
BENEPROTEIN ORAL POWDER PACKET,50052,CDM,270,RC,,,Outpatient,,,5.43,3.801,,4.34,80,,3.472,percent of total Billed Charges,80% of Total Billed Charges,3.42,63,,2.736,percent of total Billed charges,63% of Total Billed Charges,3.37,62,,2.696,percent of total Billed Charges,62% of total BIlled charges,3.42,63,,2.736,percent of total Billed Charges,63% of total Billed Charges,4.62,85,,3.696,percent of total Billed Charges,85% of total Billed Charges,4.34,80,,3.472,percent of total Billed Charges,80% of total Billed Charges,3.37,62,,2.696,percent of total Billed Charges,62% of total Billed Charges,3.42,63,,2.736,percent of total Billed Charges,63% of total Billed Charges,3.37,62,,2.696,percent of total Billed Charges,62% of total Billed Charges,3.42,63,,2.736,percent of total billed charges,63% of total Billed Charges,3.37,62,,2.696,percent of total Billed Charges,62% of total Billed Charges,4.34,80,,3.472,percent of total Billed Charges,80% of Total Billed Charges,3.37,62,,2.696,percent of total Billed Charges,62% of total Billed Charges,3.37,62,,2.696,percent of total Billed Charges,62% of total Billed Charges,3.37,4.62,
BENEPROTEIN ORAL POWDER PACKET,72235,CDM,270,RC,,,Outpatient,,,6.51,4.557,,5.21,80,,4.168,percent of total Billed Charges,80% of Total Billed Charges,4.1,63,,3.28,percent of total Billed charges,63% of Total Billed Charges,4.04,62,,3.232,percent of total Billed Charges,62% of total BIlled charges,4.1,63,,3.28,percent of total Billed Charges,63% of total Billed Charges,5.53,85,,4.424,percent of total Billed Charges,85% of total Billed Charges,5.21,80,,4.168,percent of total Billed Charges,80% of total Billed Charges,4.04,62,,3.232,percent of total Billed Charges,62% of total Billed Charges,4.1,63,,3.28,percent of total Billed Charges,63% of total Billed Charges,4.04,62,,3.232,percent of total Billed Charges,62% of total Billed Charges,4.1,63,,3.28,percent of total billed charges,63% of total Billed Charges,4.04,62,,3.232,percent of total Billed Charges,62% of total Billed Charges,5.21,80,,4.168,percent of total Billed Charges,80% of Total Billed Charges,4.04,62,,3.232,percent of total Billed Charges,62% of total Billed Charges,4.04,62,,3.232,percent of total Billed Charges,62% of total Billed Charges,4.04,5.53,
BENEPROTEIN ORAL POWDER PACKET,70874,CDM,270,RC,,,Outpatient,,,9.66,6.762,,7.73,80,,6.184,percent of total Billed Charges,80% of Total Billed Charges,6.09,63,,4.872,percent of total Billed charges,63% of Total Billed Charges,5.99,62,,4.792,percent of total Billed Charges,62% of total BIlled charges,6.09,63,,4.872,percent of total Billed Charges,63% of total Billed Charges,8.21,85,,6.568,percent of total Billed Charges,85% of total Billed Charges,7.73,80,,6.184,percent of total Billed Charges,80% of total Billed Charges,5.99,62,,4.792,percent of total Billed Charges,62% of total Billed Charges,6.09,63,,4.872,percent of total Billed Charges,63% of total Billed Charges,5.99,62,,4.792,percent of total Billed Charges,62% of total Billed Charges,6.09,63,,4.872,percent of total billed charges,63% of total Billed Charges,5.99,62,,4.792,percent of total Billed Charges,62% of total Billed Charges,7.73,80,,6.184,percent of total Billed Charges,80% of Total Billed Charges,5.99,62,,4.792,percent of total Billed Charges,62% of total Billed Charges,5.99,62,,4.792,percent of total Billed Charges,62% of total Billed Charges,5.99,8.21,
BENEPROTEIN ORAL POWDER PACKET,70873,CDM,270,RC,,,Outpatient,,,14.18,9.926,,11.34,80,,9.072,percent of total Billed Charges,80% of Total Billed Charges,8.93,63,,7.144,percent of total Billed charges,63% of Total Billed Charges,8.79,62,,7.032,percent of total Billed Charges,62% of total BIlled charges,8.93,63,,7.144,percent of total Billed Charges,63% of total Billed Charges,12.05,85,,9.64,percent of total Billed Charges,85% of total Billed Charges,11.34,80,,9.072,percent of total Billed Charges,80% of total Billed Charges,8.79,62,,7.032,percent of total Billed Charges,62% of total Billed Charges,8.93,63,,7.144,percent of total Billed Charges,63% of total Billed Charges,8.79,62,,7.032,percent of total Billed Charges,62% of total Billed Charges,8.93,63,,7.144,percent of total billed charges,63% of total Billed Charges,8.79,62,,7.032,percent of total Billed Charges,62% of total Billed Charges,11.34,80,,9.072,percent of total Billed Charges,80% of Total Billed Charges,8.79,62,,7.032,percent of total Billed Charges,62% of total Billed Charges,8.79,62,,7.032,percent of total Billed Charges,62% of total Billed Charges,8.79,12.05,
BENEPROTEIN ORAL POWDER PACKET,70130,CDM,270,RC,,,Outpatient,,,13.5,9.45,,10.8,80,,8.64,percent of total Billed Charges,80% of Total Billed Charges,8.51,63,,6.808,percent of total Billed charges,63% of Total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total BIlled charges,8.51,63,,6.808,percent of total Billed Charges,63% of total Billed Charges,11.48,85,,9.184,percent of total Billed Charges,85% of total Billed Charges,10.8,80,,8.64,percent of total Billed Charges,80% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.51,63,,6.808,percent of total Billed Charges,63% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.51,63,,6.808,percent of total billed charges,63% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,10.8,80,,8.64,percent of total Billed Charges,80% of Total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.37,11.48,
BENEPROTEIN ORAL POWDER PACKET,72246,CDM,270,RC,,,Outpatient,,,16,11.2,,12.8,80,,10.24,percent of total Billed Charges,80% of Total Billed Charges,10.08,63,,8.064,percent of total Billed charges,63% of Total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total BIlled charges,10.08,63,,8.064,percent of total Billed Charges,63% of total Billed Charges,13.6,85,,10.88,percent of total Billed Charges,85% of total Billed Charges,12.8,80,,10.24,percent of total Billed Charges,80% of total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total Billed Charges,10.08,63,,8.064,percent of total Billed Charges,63% of total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total Billed Charges,10.08,63,,8.064,percent of total billed charges,63% of total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total Billed Charges,12.8,80,,10.24,percent of total Billed Charges,80% of Total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total Billed Charges,9.92,13.6,
BENEPROTEIN ORAL POWDER PACKET,70793,CDM,270,RC,,,Outpatient,,,6.65,4.655,,5.32,80,,4.256,percent of total Billed Charges,80% of Total Billed Charges,4.19,63,,3.352,percent of total Billed charges,63% of Total Billed Charges,4.12,62,,3.296,percent of total Billed Charges,62% of total BIlled charges,4.19,63,,3.352,percent of total Billed Charges,63% of total Billed Charges,5.65,85,,4.52,percent of total Billed Charges,85% of total Billed Charges,5.32,80,,4.256,percent of total Billed Charges,80% of total Billed Charges,4.12,62,,3.296,percent of total Billed Charges,62% of total Billed Charges,4.19,63,,3.352,percent of total Billed Charges,63% of total Billed Charges,4.12,62,,3.296,percent of total Billed Charges,62% of total Billed Charges,4.19,63,,3.352,percent of total billed charges,63% of total Billed Charges,4.12,62,,3.296,percent of total Billed Charges,62% of total Billed Charges,5.32,80,,4.256,percent of total Billed Charges,80% of Total Billed Charges,4.12,62,,3.296,percent of total Billed Charges,62% of total Billed Charges,4.12,62,,3.296,percent of total Billed Charges,62% of total Billed Charges,4.12,5.65,
BENEPROTEIN ORAL POWDER PACKET,71775,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71774,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70108,CDM,270,RC,,,Outpatient,,,11,7.7,,8.8,80,,7.04,percent of total Billed Charges,80% of Total Billed Charges,6.93,63,,5.544,percent of total Billed charges,63% of Total Billed Charges,6.82,62,,5.456,percent of total Billed Charges,62% of total BIlled charges,6.93,63,,5.544,percent of total Billed Charges,63% of total Billed Charges,9.35,85,,7.48,percent of total Billed Charges,85% of total Billed Charges,8.8,80,,7.04,percent of total Billed Charges,80% of total Billed Charges,6.82,62,,5.456,percent of total Billed Charges,62% of total Billed Charges,6.93,63,,5.544,percent of total Billed Charges,63% of total Billed Charges,6.82,62,,5.456,percent of total Billed Charges,62% of total Billed Charges,6.93,63,,5.544,percent of total billed charges,63% of total Billed Charges,6.82,62,,5.456,percent of total Billed Charges,62% of total Billed Charges,8.8,80,,7.04,percent of total Billed Charges,80% of Total Billed Charges,6.82,62,,5.456,percent of total Billed Charges,62% of total Billed Charges,6.82,62,,5.456,percent of total Billed Charges,62% of total Billed Charges,6.82,9.35,
BENEPROTEIN ORAL POWDER PACKET,71778,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70518,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70869,CDM,270,RC,,,Outpatient,,,91,63.7,,72.8,80,,58.24,percent of total Billed Charges,80% of Total Billed Charges,57.33,63,,45.864,percent of total Billed charges,63% of Total Billed Charges,56.42,62,,45.136,percent of total Billed Charges,62% of total BIlled charges,57.33,63,,45.864,percent of total Billed Charges,63% of total Billed Charges,77.35,85,,61.88,percent of total Billed Charges,85% of total Billed Charges,72.8,80,,58.24,percent of total Billed Charges,80% of total Billed Charges,56.42,62,,45.136,percent of total Billed Charges,62% of total Billed Charges,57.33,63,,45.864,percent of total Billed Charges,63% of total Billed Charges,56.42,62,,45.136,percent of total Billed Charges,62% of total Billed Charges,57.33,63,,45.864,percent of total billed charges,63% of total Billed Charges,56.42,62,,45.136,percent of total Billed Charges,62% of total Billed Charges,72.8,80,,58.24,percent of total Billed Charges,80% of Total Billed Charges,56.42,62,,45.136,percent of total Billed Charges,62% of total Billed Charges,56.42,62,,45.136,percent of total Billed Charges,62% of total Billed Charges,56.42,77.35,
BENEPROTEIN ORAL POWDER PACKET,70870,CDM,270,RC,,,Outpatient,,,91,63.7,,72.8,80,,58.24,percent of total Billed Charges,80% of Total Billed Charges,57.33,63,,45.864,percent of total Billed charges,63% of Total Billed Charges,56.42,62,,45.136,percent of total Billed Charges,62% of total BIlled charges,57.33,63,,45.864,percent of total Billed Charges,63% of total Billed Charges,77.35,85,,61.88,percent of total Billed Charges,85% of total Billed Charges,72.8,80,,58.24,percent of total Billed Charges,80% of total Billed Charges,56.42,62,,45.136,percent of total Billed Charges,62% of total Billed Charges,57.33,63,,45.864,percent of total Billed Charges,63% of total Billed Charges,56.42,62,,45.136,percent of total Billed Charges,62% of total Billed Charges,57.33,63,,45.864,percent of total billed charges,63% of total Billed Charges,56.42,62,,45.136,percent of total Billed Charges,62% of total Billed Charges,72.8,80,,58.24,percent of total Billed Charges,80% of Total Billed Charges,56.42,62,,45.136,percent of total Billed Charges,62% of total Billed Charges,56.42,62,,45.136,percent of total Billed Charges,62% of total Billed Charges,56.42,77.35,
BENEPROTEIN ORAL POWDER PACKET,70110,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71856,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70111,CDM,270,RC,,,Outpatient,,,6,4.2,,4.8,80,,3.84,percent of total Billed Charges,80% of Total Billed Charges,3.78,63,,3.024,percent of total Billed charges,63% of Total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total BIlled charges,3.78,63,,3.024,percent of total Billed Charges,63% of total Billed Charges,5.1,85,,4.08,percent of total Billed Charges,85% of total Billed Charges,4.8,80,,3.84,percent of total Billed Charges,80% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.78,63,,3.024,percent of total Billed Charges,63% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.78,63,,3.024,percent of total billed charges,63% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,4.8,80,,3.84,percent of total Billed Charges,80% of Total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.72,5.1,
BENEPROTEIN ORAL POWDER PACKET,50020,CDM,270,RC,,,Outpatient,,,26.92,18.844,,21.54,80,,17.232,percent of total Billed Charges,80% of Total Billed Charges,16.96,63,,13.568,percent of total Billed charges,63% of Total Billed Charges,16.69,62,,13.352,percent of total Billed Charges,62% of total BIlled charges,16.96,63,,13.568,percent of total Billed Charges,63% of total Billed Charges,22.88,85,,18.304,percent of total Billed Charges,85% of total Billed Charges,21.54,80,,17.232,percent of total Billed Charges,80% of total Billed Charges,16.69,62,,13.352,percent of total Billed Charges,62% of total Billed Charges,16.96,63,,13.568,percent of total Billed Charges,63% of total Billed Charges,16.69,62,,13.352,percent of total Billed Charges,62% of total Billed Charges,16.96,63,,13.568,percent of total billed charges,63% of total Billed Charges,16.69,62,,13.352,percent of total Billed Charges,62% of total Billed Charges,21.54,80,,17.232,percent of total Billed Charges,80% of Total Billed Charges,16.69,62,,13.352,percent of total Billed Charges,62% of total Billed Charges,16.69,62,,13.352,percent of total Billed Charges,62% of total Billed Charges,16.69,22.88,
BENEPROTEIN ORAL POWDER PACKET,50019,CDM,270,RC,,,Outpatient,,,42,29.4,,33.6,80,,26.88,percent of total Billed Charges,80% of Total Billed Charges,26.46,63,,21.168,percent of total Billed charges,63% of Total Billed Charges,26.04,62,,20.832,percent of total Billed Charges,62% of total BIlled charges,26.46,63,,21.168,percent of total Billed Charges,63% of total Billed Charges,35.7,85,,28.56,percent of total Billed Charges,85% of total Billed Charges,33.6,80,,26.88,percent of total Billed Charges,80% of total Billed Charges,26.04,62,,20.832,percent of total Billed Charges,62% of total Billed Charges,26.46,63,,21.168,percent of total Billed Charges,63% of total Billed Charges,26.04,62,,20.832,percent of total Billed Charges,62% of total Billed Charges,26.46,63,,21.168,percent of total billed charges,63% of total Billed Charges,26.04,62,,20.832,percent of total Billed Charges,62% of total Billed Charges,33.6,80,,26.88,percent of total Billed Charges,80% of Total Billed Charges,26.04,62,,20.832,percent of total Billed Charges,62% of total Billed Charges,26.04,62,,20.832,percent of total Billed Charges,62% of total Billed Charges,26.04,35.7,
BENEPROTEIN ORAL POWDER PACKET,50095,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72064,CDM,270,RC,,,Outpatient,,,5.6,3.92,,4.48,80,,3.584,percent of total Billed Charges,80% of Total Billed Charges,3.53,63,,2.824,percent of total Billed charges,63% of Total Billed Charges,3.47,62,,2.776,percent of total Billed Charges,62% of total BIlled charges,3.53,63,,2.824,percent of total Billed Charges,63% of total Billed Charges,4.76,85,,3.808,percent of total Billed Charges,85% of total Billed Charges,4.48,80,,3.584,percent of total Billed Charges,80% of total Billed Charges,3.47,62,,2.776,percent of total Billed Charges,62% of total Billed Charges,3.53,63,,2.824,percent of total Billed Charges,63% of total Billed Charges,3.47,62,,2.776,percent of total Billed Charges,62% of total Billed Charges,3.53,63,,2.824,percent of total billed charges,63% of total Billed Charges,3.47,62,,2.776,percent of total Billed Charges,62% of total Billed Charges,4.48,80,,3.584,percent of total Billed Charges,80% of Total Billed Charges,3.47,62,,2.776,percent of total Billed Charges,62% of total Billed Charges,3.47,62,,2.776,percent of total Billed Charges,62% of total Billed Charges,3.47,4.76,
BENEPROTEIN ORAL POWDER PACKET,72319,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71732,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71733,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70200,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70114,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70290,CDM,270,RC,,,Outpatient,,,14.7,10.29,,11.76,80,,9.408,percent of total Billed Charges,80% of Total Billed Charges,9.26,63,,7.408,percent of total Billed charges,63% of Total Billed Charges,9.11,62,,7.288,percent of total Billed Charges,62% of total BIlled charges,9.26,63,,7.408,percent of total Billed Charges,63% of total Billed Charges,12.5,85,,10,percent of total Billed Charges,85% of total Billed Charges,11.76,80,,9.408,percent of total Billed Charges,80% of total Billed Charges,9.11,62,,7.288,percent of total Billed Charges,62% of total Billed Charges,9.26,63,,7.408,percent of total Billed Charges,63% of total Billed Charges,9.11,62,,7.288,percent of total Billed Charges,62% of total Billed Charges,9.26,63,,7.408,percent of total billed charges,63% of total Billed Charges,9.11,62,,7.288,percent of total Billed Charges,62% of total Billed Charges,11.76,80,,9.408,percent of total Billed Charges,80% of Total Billed Charges,9.11,62,,7.288,percent of total Billed Charges,62% of total Billed Charges,9.11,62,,7.288,percent of total Billed Charges,62% of total Billed Charges,9.11,12.5,
BENEPROTEIN ORAL POWDER PACKET,70116,CDM,270,RC,,,Outpatient,,,6.2,4.34,,4.96,80,,3.968,percent of total Billed Charges,80% of Total Billed Charges,3.91,63,,3.128,percent of total Billed charges,63% of Total Billed Charges,3.84,62,,3.072,percent of total Billed Charges,62% of total BIlled charges,3.91,63,,3.128,percent of total Billed Charges,63% of total Billed Charges,5.27,85,,4.216,percent of total Billed Charges,85% of total Billed Charges,4.96,80,,3.968,percent of total Billed Charges,80% of total Billed Charges,3.84,62,,3.072,percent of total Billed Charges,62% of total Billed Charges,3.91,63,,3.128,percent of total Billed Charges,63% of total Billed Charges,3.84,62,,3.072,percent of total Billed Charges,62% of total Billed Charges,3.91,63,,3.128,percent of total billed charges,63% of total Billed Charges,3.84,62,,3.072,percent of total Billed Charges,62% of total Billed Charges,4.96,80,,3.968,percent of total Billed Charges,80% of Total Billed Charges,3.84,62,,3.072,percent of total Billed Charges,62% of total Billed Charges,3.84,62,,3.072,percent of total Billed Charges,62% of total Billed Charges,3.84,5.27,
BENEPROTEIN ORAL POWDER PACKET,70120,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,50125,CDM,270,RC,,,Outpatient,,,9.56,6.692,,7.65,80,,6.12,percent of total Billed Charges,80% of Total Billed Charges,6.02,63,,4.816,percent of total Billed charges,63% of Total Billed Charges,5.93,62,,4.744,percent of total Billed Charges,62% of total BIlled charges,6.02,63,,4.816,percent of total Billed Charges,63% of total Billed Charges,8.13,85,,6.504,percent of total Billed Charges,85% of total Billed Charges,7.65,80,,6.12,percent of total Billed Charges,80% of total Billed Charges,5.93,62,,4.744,percent of total Billed Charges,62% of total Billed Charges,6.02,63,,4.816,percent of total Billed Charges,63% of total Billed Charges,5.93,62,,4.744,percent of total Billed Charges,62% of total Billed Charges,6.02,63,,4.816,percent of total billed charges,63% of total Billed Charges,5.93,62,,4.744,percent of total Billed Charges,62% of total Billed Charges,7.65,80,,6.12,percent of total Billed Charges,80% of Total Billed Charges,5.93,62,,4.744,percent of total Billed Charges,62% of total Billed Charges,5.93,62,,4.744,percent of total Billed Charges,62% of total Billed Charges,5.93,8.13,
BENEPROTEIN ORAL POWDER PACKET,70118,CDM,270,RC,,,Outpatient,,,11.13,7.791,,8.9,80,,7.12,percent of total Billed Charges,80% of Total Billed Charges,7.01,63,,5.608,percent of total Billed charges,63% of Total Billed Charges,6.9,62,,5.52,percent of total Billed Charges,62% of total BIlled charges,7.01,63,,5.608,percent of total Billed Charges,63% of total Billed Charges,9.46,85,,7.568,percent of total Billed Charges,85% of total Billed Charges,8.9,80,,7.12,percent of total Billed Charges,80% of total Billed Charges,6.9,62,,5.52,percent of total Billed Charges,62% of total Billed Charges,7.01,63,,5.608,percent of total Billed Charges,63% of total Billed Charges,6.9,62,,5.52,percent of total Billed Charges,62% of total Billed Charges,7.01,63,,5.608,percent of total billed charges,63% of total Billed Charges,6.9,62,,5.52,percent of total Billed Charges,62% of total Billed Charges,8.9,80,,7.12,percent of total Billed Charges,80% of Total Billed Charges,6.9,62,,5.52,percent of total Billed Charges,62% of total Billed Charges,6.9,62,,5.52,percent of total Billed Charges,62% of total Billed Charges,6.9,9.46,
BENEPROTEIN ORAL POWDER PACKET,70124,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,130030,CDM,270,RC,,,Outpatient,,,6,4.2,,4.8,80,,3.84,percent of total Billed Charges,80% of Total Billed Charges,3.78,63,,3.024,percent of total Billed charges,63% of Total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total BIlled charges,3.78,63,,3.024,percent of total Billed Charges,63% of total Billed Charges,5.1,85,,4.08,percent of total Billed Charges,85% of total Billed Charges,4.8,80,,3.84,percent of total Billed Charges,80% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.78,63,,3.024,percent of total Billed Charges,63% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.78,63,,3.024,percent of total billed charges,63% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,4.8,80,,3.84,percent of total Billed Charges,80% of Total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.72,5.1,
BENEPROTEIN ORAL POWDER PACKET,70872,CDM,270,RC,,,Outpatient,,,5.39,3.773,,4.31,80,,3.448,percent of total Billed Charges,80% of Total Billed Charges,3.4,63,,2.72,percent of total Billed charges,63% of Total Billed Charges,3.34,62,,2.672,percent of total Billed Charges,62% of total BIlled charges,3.4,63,,2.72,percent of total Billed Charges,63% of total Billed Charges,4.58,85,,3.664,percent of total Billed Charges,85% of total Billed Charges,4.31,80,,3.448,percent of total Billed Charges,80% of total Billed Charges,3.34,62,,2.672,percent of total Billed Charges,62% of total Billed Charges,3.4,63,,2.72,percent of total Billed Charges,63% of total Billed Charges,3.34,62,,2.672,percent of total Billed Charges,62% of total Billed Charges,3.4,63,,2.72,percent of total billed charges,63% of total Billed Charges,3.34,62,,2.672,percent of total Billed Charges,62% of total Billed Charges,4.31,80,,3.448,percent of total Billed Charges,80% of Total Billed Charges,3.34,62,,2.672,percent of total Billed Charges,62% of total Billed Charges,3.34,62,,2.672,percent of total Billed Charges,62% of total Billed Charges,3.34,4.58,
BENEPROTEIN ORAL POWDER PACKET,50138,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70448,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70127,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70166,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70167,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70168,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70169,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71591,CDM,270,RC,,,Outpatient,,,756.25,529.375,,605,80,,484,percent of total Billed Charges,80% of Total Billed Charges,476.44,63,,381.152,percent of total Billed charges,63% of Total Billed Charges,468.88,62,,375.104,percent of total Billed Charges,62% of total BIlled charges,476.44,63,,381.152,percent of total Billed Charges,63% of total Billed Charges,642.81,85,,514.248,percent of total Billed Charges,85% of total Billed Charges,605,80,,484,percent of total Billed Charges,80% of total Billed Charges,468.88,62,,375.104,percent of total Billed Charges,62% of total Billed Charges,476.44,63,,381.152,percent of total Billed Charges,63% of total Billed Charges,468.88,62,,375.104,percent of total Billed Charges,62% of total Billed Charges,476.44,63,,381.152,percent of total billed charges,63% of total Billed Charges,468.88,62,,375.104,percent of total Billed Charges,62% of total Billed Charges,605,80,,484,percent of total Billed Charges,80% of Total Billed Charges,468.88,62,,375.104,percent of total Billed Charges,62% of total Billed Charges,468.88,62,,375.104,percent of total Billed Charges,62% of total Billed Charges,468.88,642.81,
BENEPROTEIN ORAL POWDER PACKET,70133,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70271,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70157,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72176,CDM,270,RC,,,Outpatient,,,87.5,61.25,,70,80,,56,percent of total Billed Charges,80% of Total Billed Charges,55.13,63,,44.104,percent of total Billed charges,63% of Total Billed Charges,54.25,62,,43.4,percent of total Billed Charges,62% of total BIlled charges,55.13,63,,44.104,percent of total Billed Charges,63% of total Billed Charges,74.38,85,,59.504,percent of total Billed Charges,85% of total Billed Charges,70,80,,56,percent of total Billed Charges,80% of total Billed Charges,54.25,62,,43.4,percent of total Billed Charges,62% of total Billed Charges,55.13,63,,44.104,percent of total Billed Charges,63% of total Billed Charges,54.25,62,,43.4,percent of total Billed Charges,62% of total Billed Charges,55.13,63,,44.104,percent of total billed charges,63% of total Billed Charges,54.25,62,,43.4,percent of total Billed Charges,62% of total Billed Charges,70,80,,56,percent of total Billed Charges,80% of Total Billed Charges,54.25,62,,43.4,percent of total Billed Charges,62% of total Billed Charges,54.25,62,,43.4,percent of total Billed Charges,62% of total Billed Charges,54.25,74.38,
BENEPROTEIN ORAL POWDER PACKET,72125,CDM,270,RC,,,Outpatient,,,119.47,83.629,,95.58,80,,76.464,percent of total Billed Charges,80% of Total Billed Charges,75.27,63,,60.216,percent of total Billed charges,63% of Total Billed Charges,74.07,62,,59.256,percent of total Billed Charges,62% of total BIlled charges,75.27,63,,60.216,percent of total Billed Charges,63% of total Billed Charges,101.55,85,,81.24,percent of total Billed Charges,85% of total Billed Charges,95.58,80,,76.464,percent of total Billed Charges,80% of total Billed Charges,74.07,62,,59.256,percent of total Billed Charges,62% of total Billed Charges,75.27,63,,60.216,percent of total Billed Charges,63% of total Billed Charges,74.07,62,,59.256,percent of total Billed Charges,62% of total Billed Charges,75.27,63,,60.216,percent of total billed charges,63% of total Billed Charges,74.07,62,,59.256,percent of total Billed Charges,62% of total Billed Charges,95.58,80,,76.464,percent of total Billed Charges,80% of Total Billed Charges,74.07,62,,59.256,percent of total Billed Charges,62% of total Billed Charges,74.07,62,,59.256,percent of total Billed Charges,62% of total Billed Charges,74.07,101.55,
BENEPROTEIN ORAL POWDER PACKET,72122,CDM,270,RC,,,Outpatient,,,159.87,111.909,,127.9,80,,102.32,percent of total Billed Charges,80% of Total Billed Charges,100.72,63,,80.576,percent of total Billed charges,63% of Total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total BIlled charges,100.72,63,,80.576,percent of total Billed Charges,63% of total Billed Charges,135.89,85,,108.712,percent of total Billed Charges,85% of total Billed Charges,127.9,80,,102.32,percent of total Billed Charges,80% of total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,100.72,63,,80.576,percent of total Billed Charges,63% of total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,100.72,63,,80.576,percent of total billed charges,63% of total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,127.9,80,,102.32,percent of total Billed Charges,80% of Total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,99.12,135.89,
BENEPROTEIN ORAL POWDER PACKET,72123,CDM,270,RC,,,Outpatient,,,120.5,84.35,,96.4,80,,77.12,percent of total Billed Charges,80% of Total Billed Charges,75.92,63,,60.736,percent of total Billed charges,63% of Total Billed Charges,74.71,62,,59.768,percent of total Billed Charges,62% of total BIlled charges,75.92,63,,60.736,percent of total Billed Charges,63% of total Billed Charges,102.43,85,,81.944,percent of total Billed Charges,85% of total Billed Charges,96.4,80,,77.12,percent of total Billed Charges,80% of total Billed Charges,74.71,62,,59.768,percent of total Billed Charges,62% of total Billed Charges,75.92,63,,60.736,percent of total Billed Charges,63% of total Billed Charges,74.71,62,,59.768,percent of total Billed Charges,62% of total Billed Charges,75.92,63,,60.736,percent of total billed charges,63% of total Billed Charges,74.71,62,,59.768,percent of total Billed Charges,62% of total Billed Charges,96.4,80,,77.12,percent of total Billed Charges,80% of Total Billed Charges,74.71,62,,59.768,percent of total Billed Charges,62% of total Billed Charges,74.71,62,,59.768,percent of total Billed Charges,62% of total Billed Charges,74.71,102.43,
BENEPROTEIN ORAL POWDER PACKET,72124,CDM,270,RC,,,Outpatient,,,161,112.7,,128.8,80,,103.04,percent of total Billed Charges,80% of Total Billed Charges,101.43,63,,81.144,percent of total Billed charges,63% of Total Billed Charges,99.82,62,,79.856,percent of total Billed Charges,62% of total BIlled charges,101.43,63,,81.144,percent of total Billed Charges,63% of total Billed Charges,136.85,85,,109.48,percent of total Billed Charges,85% of total Billed Charges,128.8,80,,103.04,percent of total Billed Charges,80% of total Billed Charges,99.82,62,,79.856,percent of total Billed Charges,62% of total Billed Charges,101.43,63,,81.144,percent of total Billed Charges,63% of total Billed Charges,99.82,62,,79.856,percent of total Billed Charges,62% of total Billed Charges,101.43,63,,81.144,percent of total billed charges,63% of total Billed Charges,99.82,62,,79.856,percent of total Billed Charges,62% of total Billed Charges,128.8,80,,103.04,percent of total Billed Charges,80% of Total Billed Charges,99.82,62,,79.856,percent of total Billed Charges,62% of total Billed Charges,99.82,62,,79.856,percent of total Billed Charges,62% of total Billed Charges,99.82,136.85,
BENEPROTEIN ORAL POWDER PACKET,71522,CDM,270,RC,,,Outpatient,,,48.65,34.055,,38.92,80,,31.136,percent of total Billed Charges,80% of Total Billed Charges,30.65,63,,24.52,percent of total Billed charges,63% of Total Billed Charges,30.16,62,,24.128,percent of total Billed Charges,62% of total BIlled charges,30.65,63,,24.52,percent of total Billed Charges,63% of total Billed Charges,41.35,85,,33.08,percent of total Billed Charges,85% of total Billed Charges,38.92,80,,31.136,percent of total Billed Charges,80% of total Billed Charges,30.16,62,,24.128,percent of total Billed Charges,62% of total Billed Charges,30.65,63,,24.52,percent of total Billed Charges,63% of total Billed Charges,30.16,62,,24.128,percent of total Billed Charges,62% of total Billed Charges,30.65,63,,24.52,percent of total billed charges,63% of total Billed Charges,30.16,62,,24.128,percent of total Billed Charges,62% of total Billed Charges,38.92,80,,31.136,percent of total Billed Charges,80% of Total Billed Charges,30.16,62,,24.128,percent of total Billed Charges,62% of total Billed Charges,30.16,62,,24.128,percent of total Billed Charges,62% of total Billed Charges,30.16,41.35,
BENEPROTEIN ORAL POWDER PACKET,72065,CDM,270,RC,,,Outpatient,,,15,10.5,,12,80,,9.6,percent of total Billed Charges,80% of Total Billed Charges,9.45,63,,7.56,percent of total Billed charges,63% of Total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total BIlled charges,9.45,63,,7.56,percent of total Billed Charges,63% of total Billed Charges,12.75,85,,10.2,percent of total Billed Charges,85% of total Billed Charges,12,80,,9.6,percent of total Billed Charges,80% of total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total Billed Charges,9.45,63,,7.56,percent of total Billed Charges,63% of total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total Billed Charges,9.45,63,,7.56,percent of total billed charges,63% of total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total Billed Charges,12,80,,9.6,percent of total Billed Charges,80% of Total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total Billed Charges,9.3,12.75,
BENEPROTEIN ORAL POWDER PACKET,72129,CDM,270,RC,,,Outpatient,,,11.17,7.819,,8.94,80,,7.152,percent of total Billed Charges,80% of Total Billed Charges,7.04,63,,5.632,percent of total Billed charges,63% of Total Billed Charges,6.93,62,,5.544,percent of total Billed Charges,62% of total BIlled charges,7.04,63,,5.632,percent of total Billed Charges,63% of total Billed Charges,9.49,85,,7.592,percent of total Billed Charges,85% of total Billed Charges,8.94,80,,7.152,percent of total Billed Charges,80% of total Billed Charges,6.93,62,,5.544,percent of total Billed Charges,62% of total Billed Charges,7.04,63,,5.632,percent of total Billed Charges,63% of total Billed Charges,6.93,62,,5.544,percent of total Billed Charges,62% of total Billed Charges,7.04,63,,5.632,percent of total billed charges,63% of total Billed Charges,6.93,62,,5.544,percent of total Billed Charges,62% of total Billed Charges,8.94,80,,7.152,percent of total Billed Charges,80% of Total Billed Charges,6.93,62,,5.544,percent of total Billed Charges,62% of total Billed Charges,6.93,62,,5.544,percent of total Billed Charges,62% of total Billed Charges,6.93,9.49,
BENEPROTEIN ORAL POWDER PACKET,70170,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72193,CDM,270,RC,,,Outpatient,,,254.28,177.996,,203.42,80,,162.736,percent of total Billed Charges,80% of Total Billed Charges,160.2,63,,128.16,percent of total Billed charges,63% of Total Billed Charges,157.65,62,,126.12,percent of total Billed Charges,62% of total BIlled charges,160.2,63,,128.16,percent of total Billed Charges,63% of total Billed Charges,216.14,85,,172.912,percent of total Billed Charges,85% of total Billed Charges,203.42,80,,162.736,percent of total Billed Charges,80% of total Billed Charges,157.65,62,,126.12,percent of total Billed Charges,62% of total Billed Charges,160.2,63,,128.16,percent of total Billed Charges,63% of total Billed Charges,157.65,62,,126.12,percent of total Billed Charges,62% of total Billed Charges,160.2,63,,128.16,percent of total billed charges,63% of total Billed Charges,157.65,62,,126.12,percent of total Billed Charges,62% of total Billed Charges,203.42,80,,162.736,percent of total Billed Charges,80% of Total Billed Charges,157.65,62,,126.12,percent of total Billed Charges,62% of total Billed Charges,157.65,62,,126.12,percent of total Billed Charges,62% of total Billed Charges,157.65,216.14,
BENEPROTEIN ORAL POWDER PACKET,50107,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70703,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70135,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71630,CDM,270,RC,,,Outpatient,,,30.24,21.168,,24.19,80,,19.352,percent of total Billed Charges,80% of Total Billed Charges,19.05,63,,15.24,percent of total Billed charges,63% of Total Billed Charges,18.75,62,,15,percent of total Billed Charges,62% of total BIlled charges,19.05,63,,15.24,percent of total Billed Charges,63% of total Billed Charges,25.7,85,,20.56,percent of total Billed Charges,85% of total Billed Charges,24.19,80,,19.352,percent of total Billed Charges,80% of total Billed Charges,18.75,62,,15,percent of total Billed Charges,62% of total Billed Charges,19.05,63,,15.24,percent of total Billed Charges,63% of total Billed Charges,18.75,62,,15,percent of total Billed Charges,62% of total Billed Charges,19.05,63,,15.24,percent of total billed charges,63% of total Billed Charges,18.75,62,,15,percent of total Billed Charges,62% of total Billed Charges,24.19,80,,19.352,percent of total Billed Charges,80% of Total Billed Charges,18.75,62,,15,percent of total Billed Charges,62% of total Billed Charges,18.75,62,,15,percent of total Billed Charges,62% of total Billed Charges,18.75,25.7,
BENEPROTEIN ORAL POWDER PACKET,70139,CDM,270,RC,,,Outpatient,,,36.65,25.655,,29.32,80,,23.456,percent of total Billed Charges,80% of Total Billed Charges,23.09,63,,18.472,percent of total Billed charges,63% of Total Billed Charges,22.72,62,,18.176,percent of total Billed Charges,62% of total BIlled charges,23.09,63,,18.472,percent of total Billed Charges,63% of total Billed Charges,31.15,85,,24.92,percent of total Billed Charges,85% of total Billed Charges,29.32,80,,23.456,percent of total Billed Charges,80% of total Billed Charges,22.72,62,,18.176,percent of total Billed Charges,62% of total Billed Charges,23.09,63,,18.472,percent of total Billed Charges,63% of total Billed Charges,22.72,62,,18.176,percent of total Billed Charges,62% of total Billed Charges,23.09,63,,18.472,percent of total billed charges,63% of total Billed Charges,22.72,62,,18.176,percent of total Billed Charges,62% of total Billed Charges,29.32,80,,23.456,percent of total Billed Charges,80% of Total Billed Charges,22.72,62,,18.176,percent of total Billed Charges,62% of total Billed Charges,22.72,62,,18.176,percent of total Billed Charges,62% of total Billed Charges,22.72,31.15,
BENEPROTEIN ORAL POWDER PACKET,71629,CDM,270,RC,,,Outpatient,,,34.06,23.842,,27.25,80,,21.8,percent of total Billed Charges,80% of Total Billed Charges,21.46,63,,17.168,percent of total Billed charges,63% of Total Billed Charges,21.12,62,,16.896,percent of total Billed Charges,62% of total BIlled charges,21.46,63,,17.168,percent of total Billed Charges,63% of total Billed Charges,28.95,85,,23.16,percent of total Billed Charges,85% of total Billed Charges,27.25,80,,21.8,percent of total Billed Charges,80% of total Billed Charges,21.12,62,,16.896,percent of total Billed Charges,62% of total Billed Charges,21.46,63,,17.168,percent of total Billed Charges,63% of total Billed Charges,21.12,62,,16.896,percent of total Billed Charges,62% of total Billed Charges,21.46,63,,17.168,percent of total billed charges,63% of total Billed Charges,21.12,62,,16.896,percent of total Billed Charges,62% of total Billed Charges,27.25,80,,21.8,percent of total Billed Charges,80% of Total Billed Charges,21.12,62,,16.896,percent of total Billed Charges,62% of total Billed Charges,21.12,62,,16.896,percent of total Billed Charges,62% of total Billed Charges,21.12,28.95,
BENEPROTEIN ORAL POWDER PACKET,71631,CDM,270,RC,,,Outpatient,,,31.71,22.197,,25.37,80,,20.296,percent of total Billed Charges,80% of Total Billed Charges,19.98,63,,15.984,percent of total Billed charges,63% of Total Billed Charges,19.66,62,,15.728,percent of total Billed Charges,62% of total BIlled charges,19.98,63,,15.984,percent of total Billed Charges,63% of total Billed Charges,26.95,85,,21.56,percent of total Billed Charges,85% of total Billed Charges,25.37,80,,20.296,percent of total Billed Charges,80% of total Billed Charges,19.66,62,,15.728,percent of total Billed Charges,62% of total Billed Charges,19.98,63,,15.984,percent of total Billed Charges,63% of total Billed Charges,19.66,62,,15.728,percent of total Billed Charges,62% of total Billed Charges,19.98,63,,15.984,percent of total billed charges,63% of total Billed Charges,19.66,62,,15.728,percent of total Billed Charges,62% of total Billed Charges,25.37,80,,20.296,percent of total Billed Charges,80% of Total Billed Charges,19.66,62,,15.728,percent of total Billed Charges,62% of total Billed Charges,19.66,62,,15.728,percent of total Billed Charges,62% of total Billed Charges,19.66,26.95,
BENEPROTEIN ORAL POWDER PACKET,72088,CDM,270,RC,,,Outpatient,,,2016.3,1411.41,,1613.04,80,,1290.432,percent of total Billed Charges,80% of Total Billed Charges,1270.27,63,,1016.216,percent of total Billed charges,63% of Total Billed Charges,1250.11,62,,1000.088,percent of total Billed Charges,62% of total BIlled charges,1270.27,63,,1016.216,percent of total Billed Charges,63% of total Billed Charges,1713.86,85,,1371.088,percent of total Billed Charges,85% of total Billed Charges,1613.04,80,,1290.432,percent of total Billed Charges,80% of total Billed Charges,1250.11,62,,1000.088,percent of total Billed Charges,62% of total Billed Charges,1270.27,63,,1016.216,percent of total Billed Charges,63% of total Billed Charges,1250.11,62,,1000.088,percent of total Billed Charges,62% of total Billed Charges,1270.27,63,,1016.216,percent of total billed charges,63% of total Billed Charges,1250.11,62,,1000.088,percent of total Billed Charges,62% of total Billed Charges,1613.04,80,,1290.432,percent of total Billed Charges,80% of Total Billed Charges,1250.11,62,,1000.088,percent of total Billed Charges,62% of total Billed Charges,1250.11,62,,1000.088,percent of total Billed Charges,62% of total Billed Charges,1250.11,1713.86,
BENEPROTEIN ORAL POWDER PACKET,70501,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70502,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71055,CDM,270,RC,,,Outpatient,,,81.5,57.05,,65.2,80,,52.16,percent of total Billed Charges,80% of Total Billed Charges,51.35,63,,41.08,percent of total Billed charges,63% of Total Billed Charges,50.53,62,,40.424,percent of total Billed Charges,62% of total BIlled charges,51.35,63,,41.08,percent of total Billed Charges,63% of total Billed Charges,69.28,85,,55.424,percent of total Billed Charges,85% of total Billed Charges,65.2,80,,52.16,percent of total Billed Charges,80% of total Billed Charges,50.53,62,,40.424,percent of total Billed Charges,62% of total Billed Charges,51.35,63,,41.08,percent of total Billed Charges,63% of total Billed Charges,50.53,62,,40.424,percent of total Billed Charges,62% of total Billed Charges,51.35,63,,41.08,percent of total billed charges,63% of total Billed Charges,50.53,62,,40.424,percent of total Billed Charges,62% of total Billed Charges,65.2,80,,52.16,percent of total Billed Charges,80% of Total Billed Charges,50.53,62,,40.424,percent of total Billed Charges,62% of total Billed Charges,50.53,62,,40.424,percent of total Billed Charges,62% of total Billed Charges,50.53,69.28,
BENEPROTEIN ORAL POWDER PACKET,70143,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72309,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71085,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72241,CDM,270,RC,,,Outpatient,,,20.95,14.665,,16.76,80,,13.408,percent of total Billed Charges,80% of Total Billed Charges,13.2,63,,10.56,percent of total Billed charges,63% of Total Billed Charges,12.99,62,,10.392,percent of total Billed Charges,62% of total BIlled charges,13.2,63,,10.56,percent of total Billed Charges,63% of total Billed Charges,17.81,85,,14.248,percent of total Billed Charges,85% of total Billed Charges,16.76,80,,13.408,percent of total Billed Charges,80% of total Billed Charges,12.99,62,,10.392,percent of total Billed Charges,62% of total Billed Charges,13.2,63,,10.56,percent of total Billed Charges,63% of total Billed Charges,12.99,62,,10.392,percent of total Billed Charges,62% of total Billed Charges,13.2,63,,10.56,percent of total billed charges,63% of total Billed Charges,12.99,62,,10.392,percent of total Billed Charges,62% of total Billed Charges,16.76,80,,13.408,percent of total Billed Charges,80% of Total Billed Charges,12.99,62,,10.392,percent of total Billed Charges,62% of total Billed Charges,12.99,62,,10.392,percent of total Billed Charges,62% of total Billed Charges,12.99,17.81,
BENEPROTEIN ORAL POWDER PACKET,72029,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70280,CDM,270,RC,,,Outpatient,,,87.23,61.061,,69.78,80,,55.824,percent of total Billed Charges,80% of Total Billed Charges,54.95,63,,43.96,percent of total Billed charges,63% of Total Billed Charges,54.08,62,,43.264,percent of total Billed Charges,62% of total BIlled charges,54.95,63,,43.96,percent of total Billed Charges,63% of total Billed Charges,74.15,85,,59.32,percent of total Billed Charges,85% of total Billed Charges,69.78,80,,55.824,percent of total Billed Charges,80% of total Billed Charges,54.08,62,,43.264,percent of total Billed Charges,62% of total Billed Charges,54.95,63,,43.96,percent of total Billed Charges,63% of total Billed Charges,54.08,62,,43.264,percent of total Billed Charges,62% of total Billed Charges,54.95,63,,43.96,percent of total billed charges,63% of total Billed Charges,54.08,62,,43.264,percent of total Billed Charges,62% of total Billed Charges,69.78,80,,55.824,percent of total Billed Charges,80% of Total Billed Charges,54.08,62,,43.264,percent of total Billed Charges,62% of total Billed Charges,54.08,62,,43.264,percent of total Billed Charges,62% of total Billed Charges,54.08,74.15,
BENEPROTEIN ORAL POWDER PACKET,50117,CDM,270,RC,,,Outpatient,,,13.5,9.45,,10.8,80,,8.64,percent of total Billed Charges,80% of Total Billed Charges,8.51,63,,6.808,percent of total Billed charges,63% of Total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total BIlled charges,8.51,63,,6.808,percent of total Billed Charges,63% of total Billed Charges,11.48,85,,9.184,percent of total Billed Charges,85% of total Billed Charges,10.8,80,,8.64,percent of total Billed Charges,80% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.51,63,,6.808,percent of total Billed Charges,63% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.51,63,,6.808,percent of total billed charges,63% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,10.8,80,,8.64,percent of total Billed Charges,80% of Total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.37,11.48,
BENEPROTEIN ORAL POWDER PACKET,72210,CDM,270,RC,,,Outpatient,,,151.5,106.05,,121.2,80,,96.96,percent of total Billed Charges,80% of Total Billed Charges,95.45,63,,76.36,percent of total Billed charges,63% of Total Billed Charges,93.93,62,,75.144,percent of total Billed Charges,62% of total BIlled charges,95.45,63,,76.36,percent of total Billed Charges,63% of total Billed Charges,128.78,85,,103.024,percent of total Billed Charges,85% of total Billed Charges,121.2,80,,96.96,percent of total Billed Charges,80% of total Billed Charges,93.93,62,,75.144,percent of total Billed Charges,62% of total Billed Charges,95.45,63,,76.36,percent of total Billed Charges,63% of total Billed Charges,93.93,62,,75.144,percent of total Billed Charges,62% of total Billed Charges,95.45,63,,76.36,percent of total billed charges,63% of total Billed Charges,93.93,62,,75.144,percent of total Billed Charges,62% of total Billed Charges,121.2,80,,96.96,percent of total Billed Charges,80% of Total Billed Charges,93.93,62,,75.144,percent of total Billed Charges,62% of total Billed Charges,93.93,62,,75.144,percent of total Billed Charges,62% of total Billed Charges,93.93,128.78,
BENEPROTEIN ORAL POWDER PACKET,72341,CDM,270,RC,,,Outpatient,,,11.34,7.938,,9.07,80,,7.256,percent of total Billed Charges,80% of Total Billed Charges,7.14,63,,5.712,percent of total Billed charges,63% of Total Billed Charges,7.03,62,,5.624,percent of total Billed Charges,62% of total BIlled charges,7.14,63,,5.712,percent of total Billed Charges,63% of total Billed Charges,9.64,85,,7.712,percent of total Billed Charges,85% of total Billed Charges,9.07,80,,7.256,percent of total Billed Charges,80% of total Billed Charges,7.03,62,,5.624,percent of total Billed Charges,62% of total Billed Charges,7.14,63,,5.712,percent of total Billed Charges,63% of total Billed Charges,7.03,62,,5.624,percent of total Billed Charges,62% of total Billed Charges,7.14,63,,5.712,percent of total billed charges,63% of total Billed Charges,7.03,62,,5.624,percent of total Billed Charges,62% of total Billed Charges,9.07,80,,7.256,percent of total Billed Charges,80% of Total Billed Charges,7.03,62,,5.624,percent of total Billed Charges,62% of total Billed Charges,7.03,62,,5.624,percent of total Billed Charges,62% of total Billed Charges,7.03,9.64,
BENEPROTEIN ORAL POWDER PACKET,72130,CDM,270,RC,,,Outpatient,,,11.9,8.33,,9.52,80,,7.616,percent of total Billed Charges,80% of Total Billed Charges,7.5,63,,6,percent of total Billed charges,63% of Total Billed Charges,7.38,62,,5.904,percent of total Billed Charges,62% of total BIlled charges,7.5,63,,6,percent of total Billed Charges,63% of total Billed Charges,10.12,85,,8.096,percent of total Billed Charges,85% of total Billed Charges,9.52,80,,7.616,percent of total Billed Charges,80% of total Billed Charges,7.38,62,,5.904,percent of total Billed Charges,62% of total Billed Charges,7.5,63,,6,percent of total Billed Charges,63% of total Billed Charges,7.38,62,,5.904,percent of total Billed Charges,62% of total Billed Charges,7.5,63,,6,percent of total billed charges,63% of total Billed Charges,7.38,62,,5.904,percent of total Billed Charges,62% of total Billed Charges,9.52,80,,7.616,percent of total Billed Charges,80% of Total Billed Charges,7.38,62,,5.904,percent of total Billed Charges,62% of total Billed Charges,7.38,62,,5.904,percent of total Billed Charges,62% of total Billed Charges,7.38,10.12,
BENEPROTEIN ORAL POWDER PACKET,70148,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72054,CDM,270,RC,,,Outpatient,,,13.65,9.555,,10.92,80,,8.736,percent of total Billed Charges,80% of Total Billed Charges,8.6,63,,6.88,percent of total Billed charges,63% of Total Billed Charges,8.46,62,,6.768,percent of total Billed Charges,62% of total BIlled charges,8.6,63,,6.88,percent of total Billed Charges,63% of total Billed Charges,11.6,85,,9.28,percent of total Billed Charges,85% of total Billed Charges,10.92,80,,8.736,percent of total Billed Charges,80% of total Billed Charges,8.46,62,,6.768,percent of total Billed Charges,62% of total Billed Charges,8.6,63,,6.88,percent of total Billed Charges,63% of total Billed Charges,8.46,62,,6.768,percent of total Billed Charges,62% of total Billed Charges,8.6,63,,6.88,percent of total billed charges,63% of total Billed Charges,8.46,62,,6.768,percent of total Billed Charges,62% of total Billed Charges,10.92,80,,8.736,percent of total Billed Charges,80% of Total Billed Charges,8.46,62,,6.768,percent of total Billed Charges,62% of total Billed Charges,8.46,62,,6.768,percent of total Billed Charges,62% of total Billed Charges,8.46,11.6,
BENEPROTEIN ORAL POWDER PACKET,70151,CDM,270,RC,,,Outpatient,,,13.5,9.45,,10.8,80,,8.64,percent of total Billed Charges,80% of Total Billed Charges,8.51,63,,6.808,percent of total Billed charges,63% of Total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total BIlled charges,8.51,63,,6.808,percent of total Billed Charges,63% of total Billed Charges,11.48,85,,9.184,percent of total Billed Charges,85% of total Billed Charges,10.8,80,,8.64,percent of total Billed Charges,80% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.51,63,,6.808,percent of total Billed Charges,63% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.51,63,,6.808,percent of total billed charges,63% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,10.8,80,,8.64,percent of total Billed Charges,80% of Total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.37,11.48,
BENEPROTEIN ORAL POWDER PACKET,70152,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72058,CDM,270,RC,,,Outpatient,,,11.5,8.05,,9.2,80,,7.36,percent of total Billed Charges,80% of Total Billed Charges,7.25,63,,5.8,percent of total Billed charges,63% of Total Billed Charges,7.13,62,,5.704,percent of total Billed Charges,62% of total BIlled charges,7.25,63,,5.8,percent of total Billed Charges,63% of total Billed Charges,9.78,85,,7.824,percent of total Billed Charges,85% of total Billed Charges,9.2,80,,7.36,percent of total Billed Charges,80% of total Billed Charges,7.13,62,,5.704,percent of total Billed Charges,62% of total Billed Charges,7.25,63,,5.8,percent of total Billed Charges,63% of total Billed Charges,7.13,62,,5.704,percent of total Billed Charges,62% of total Billed Charges,7.25,63,,5.8,percent of total billed charges,63% of total Billed Charges,7.13,62,,5.704,percent of total Billed Charges,62% of total Billed Charges,9.2,80,,7.36,percent of total Billed Charges,80% of Total Billed Charges,7.13,62,,5.704,percent of total Billed Charges,62% of total Billed Charges,7.13,62,,5.704,percent of total Billed Charges,62% of total Billed Charges,7.13,9.78,
BENEPROTEIN ORAL POWDER PACKET,70484,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72316,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70156,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70158,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,150059,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72314,CDM,270,RC,,,Outpatient,,,165.6,115.92,,132.48,80,,105.984,percent of total Billed Charges,80% of Total Billed Charges,104.33,63,,83.464,percent of total Billed charges,63% of Total Billed Charges,102.67,62,,82.136,percent of total Billed Charges,62% of total BIlled charges,104.33,63,,83.464,percent of total Billed Charges,63% of total Billed Charges,140.76,85,,112.608,percent of total Billed Charges,85% of total Billed Charges,132.48,80,,105.984,percent of total Billed Charges,80% of total Billed Charges,102.67,62,,82.136,percent of total Billed Charges,62% of total Billed Charges,104.33,63,,83.464,percent of total Billed Charges,63% of total Billed Charges,102.67,62,,82.136,percent of total Billed Charges,62% of total Billed Charges,104.33,63,,83.464,percent of total billed charges,63% of total Billed Charges,102.67,62,,82.136,percent of total Billed Charges,62% of total Billed Charges,132.48,80,,105.984,percent of total Billed Charges,80% of Total Billed Charges,102.67,62,,82.136,percent of total Billed Charges,62% of total Billed Charges,102.67,62,,82.136,percent of total Billed Charges,62% of total Billed Charges,102.67,140.76,
BENEPROTEIN ORAL POWDER PACKET,72313,CDM,270,RC,,,Outpatient,,,165.6,115.92,,132.48,80,,105.984,percent of total Billed Charges,80% of Total Billed Charges,104.33,63,,83.464,percent of total Billed charges,63% of Total Billed Charges,102.67,62,,82.136,percent of total Billed Charges,62% of total BIlled charges,104.33,63,,83.464,percent of total Billed Charges,63% of total Billed Charges,140.76,85,,112.608,percent of total Billed Charges,85% of total Billed Charges,132.48,80,,105.984,percent of total Billed Charges,80% of total Billed Charges,102.67,62,,82.136,percent of total Billed Charges,62% of total Billed Charges,104.33,63,,83.464,percent of total Billed Charges,63% of total Billed Charges,102.67,62,,82.136,percent of total Billed Charges,62% of total Billed Charges,104.33,63,,83.464,percent of total billed charges,63% of total Billed Charges,102.67,62,,82.136,percent of total Billed Charges,62% of total Billed Charges,132.48,80,,105.984,percent of total Billed Charges,80% of Total Billed Charges,102.67,62,,82.136,percent of total Billed Charges,62% of total Billed Charges,102.67,62,,82.136,percent of total Billed Charges,62% of total Billed Charges,102.67,140.76,
BENEPROTEIN ORAL POWDER PACKET,72315,CDM,270,RC,,,Outpatient,,,165.6,115.92,,132.48,80,,105.984,percent of total Billed Charges,80% of Total Billed Charges,104.33,63,,83.464,percent of total Billed charges,63% of Total Billed Charges,102.67,62,,82.136,percent of total Billed Charges,62% of total BIlled charges,104.33,63,,83.464,percent of total Billed Charges,63% of total Billed Charges,140.76,85,,112.608,percent of total Billed Charges,85% of total Billed Charges,132.48,80,,105.984,percent of total Billed Charges,80% of total Billed Charges,102.67,62,,82.136,percent of total Billed Charges,62% of total Billed Charges,104.33,63,,83.464,percent of total Billed Charges,63% of total Billed Charges,102.67,62,,82.136,percent of total Billed Charges,62% of total Billed Charges,104.33,63,,83.464,percent of total billed charges,63% of total Billed Charges,102.67,62,,82.136,percent of total Billed Charges,62% of total Billed Charges,132.48,80,,105.984,percent of total Billed Charges,80% of Total Billed Charges,102.67,62,,82.136,percent of total Billed Charges,62% of total Billed Charges,102.67,62,,82.136,percent of total Billed Charges,62% of total Billed Charges,102.67,140.76,
VITAL 1.2 CAL ARC INST LIQ 24X8 OZ,72272,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
VITAL 1.5 CAL ARC INST LIQ 24X8 OZ,72273,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72105,CDM,270,RC,,,Outpatient,,,58.69,41.083,,46.95,80,,37.56,percent of total Billed Charges,80% of Total Billed Charges,36.97,63,,29.576,percent of total Billed charges,63% of Total Billed Charges,36.39,62,,29.112,percent of total Billed Charges,62% of total BIlled charges,36.97,63,,29.576,percent of total Billed Charges,63% of total Billed Charges,49.89,85,,39.912,percent of total Billed Charges,85% of total Billed Charges,46.95,80,,37.56,percent of total Billed Charges,80% of total Billed Charges,36.39,62,,29.112,percent of total Billed Charges,62% of total Billed Charges,36.97,63,,29.576,percent of total Billed Charges,63% of total Billed Charges,36.39,62,,29.112,percent of total Billed Charges,62% of total Billed Charges,36.97,63,,29.576,percent of total billed charges,63% of total Billed Charges,36.39,62,,29.112,percent of total Billed Charges,62% of total Billed Charges,46.95,80,,37.56,percent of total Billed Charges,80% of Total Billed Charges,36.39,62,,29.112,percent of total Billed Charges,62% of total Billed Charges,36.39,62,,29.112,percent of total Billed Charges,62% of total Billed Charges,36.39,49.89,
BENEPROTEIN ORAL POWDER PACKET,72142,CDM,270,RC,,,Outpatient,,,94,65.8,,75.2,80,,60.16,percent of total Billed Charges,80% of Total Billed Charges,59.22,63,,47.376,percent of total Billed charges,63% of Total Billed Charges,58.28,62,,46.624,percent of total Billed Charges,62% of total BIlled charges,59.22,63,,47.376,percent of total Billed Charges,63% of total Billed Charges,79.9,85,,63.92,percent of total Billed Charges,85% of total Billed Charges,75.2,80,,60.16,percent of total Billed Charges,80% of total Billed Charges,58.28,62,,46.624,percent of total Billed Charges,62% of total Billed Charges,59.22,63,,47.376,percent of total Billed Charges,63% of total Billed Charges,58.28,62,,46.624,percent of total Billed Charges,62% of total Billed Charges,59.22,63,,47.376,percent of total billed charges,63% of total Billed Charges,58.28,62,,46.624,percent of total Billed Charges,62% of total Billed Charges,75.2,80,,60.16,percent of total Billed Charges,80% of Total Billed Charges,58.28,62,,46.624,percent of total Billed Charges,62% of total Billed Charges,58.28,62,,46.624,percent of total Billed Charges,62% of total Billed Charges,58.28,79.9,
BENEPROTEIN ORAL POWDER PACKET,72114,CDM,270,RC,,,Outpatient,,,17,11.9,,13.6,80,,10.88,percent of total Billed Charges,80% of Total Billed Charges,10.71,63,,8.568,percent of total Billed charges,63% of Total Billed Charges,10.54,62,,8.432,percent of total Billed Charges,62% of total BIlled charges,10.71,63,,8.568,percent of total Billed Charges,63% of total Billed Charges,14.45,85,,11.56,percent of total Billed Charges,85% of total Billed Charges,13.6,80,,10.88,percent of total Billed Charges,80% of total Billed Charges,10.54,62,,8.432,percent of total Billed Charges,62% of total Billed Charges,10.71,63,,8.568,percent of total Billed Charges,63% of total Billed Charges,10.54,62,,8.432,percent of total Billed Charges,62% of total Billed Charges,10.71,63,,8.568,percent of total billed charges,63% of total Billed Charges,10.54,62,,8.432,percent of total Billed Charges,62% of total Billed Charges,13.6,80,,10.88,percent of total Billed Charges,80% of Total Billed Charges,10.54,62,,8.432,percent of total Billed Charges,62% of total Billed Charges,10.54,62,,8.432,percent of total Billed Charges,62% of total Billed Charges,10.54,14.45,
BENEPROTEIN ORAL POWDER PACKET,72113,CDM,270,RC,,,Outpatient,,,166,116.2,,132.8,80,,106.24,percent of total Billed Charges,80% of Total Billed Charges,104.58,63,,83.664,percent of total Billed charges,63% of Total Billed Charges,102.92,62,,82.336,percent of total Billed Charges,62% of total BIlled charges,104.58,63,,83.664,percent of total Billed Charges,63% of total Billed Charges,141.1,85,,112.88,percent of total Billed Charges,85% of total Billed Charges,132.8,80,,106.24,percent of total Billed Charges,80% of total Billed Charges,102.92,62,,82.336,percent of total Billed Charges,62% of total Billed Charges,104.58,63,,83.664,percent of total Billed Charges,63% of total Billed Charges,102.92,62,,82.336,percent of total Billed Charges,62% of total Billed Charges,104.58,63,,83.664,percent of total billed charges,63% of total Billed Charges,102.92,62,,82.336,percent of total Billed Charges,62% of total Billed Charges,132.8,80,,106.24,percent of total Billed Charges,80% of Total Billed Charges,102.92,62,,82.336,percent of total Billed Charges,62% of total Billed Charges,102.92,62,,82.336,percent of total Billed Charges,62% of total Billed Charges,102.92,141.1,
BENEPROTEIN ORAL POWDER PACKET,70259,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70777,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72207,CDM,270,RC,,,Outpatient,,,18.5,12.95,,14.8,80,,11.84,percent of total Billed Charges,80% of Total Billed Charges,11.66,63,,9.328,percent of total Billed charges,63% of Total Billed Charges,11.47,62,,9.176,percent of total Billed Charges,62% of total BIlled charges,11.66,63,,9.328,percent of total Billed Charges,63% of total Billed Charges,15.73,85,,12.584,percent of total Billed Charges,85% of total Billed Charges,14.8,80,,11.84,percent of total Billed Charges,80% of total Billed Charges,11.47,62,,9.176,percent of total Billed Charges,62% of total Billed Charges,11.66,63,,9.328,percent of total Billed Charges,63% of total Billed Charges,11.47,62,,9.176,percent of total Billed Charges,62% of total Billed Charges,11.66,63,,9.328,percent of total billed charges,63% of total Billed Charges,11.47,62,,9.176,percent of total Billed Charges,62% of total Billed Charges,14.8,80,,11.84,percent of total Billed Charges,80% of Total Billed Charges,11.47,62,,9.176,percent of total Billed Charges,62% of total Billed Charges,11.47,62,,9.176,percent of total Billed Charges,62% of total Billed Charges,11.47,15.73,
BENEPROTEIN ORAL POWDER PACKET,72247,CDM,270,RC,,,Outpatient,,,23.84,16.688,,19.07,80,,15.256,percent of total Billed Charges,80% of Total Billed Charges,15.02,63,,12.016,percent of total Billed charges,63% of Total Billed Charges,14.78,62,,11.824,percent of total Billed Charges,62% of total BIlled charges,15.02,63,,12.016,percent of total Billed Charges,63% of total Billed Charges,20.26,85,,16.208,percent of total Billed Charges,85% of total Billed Charges,19.07,80,,15.256,percent of total Billed Charges,80% of total Billed Charges,14.78,62,,11.824,percent of total Billed Charges,62% of total Billed Charges,15.02,63,,12.016,percent of total Billed Charges,63% of total Billed Charges,14.78,62,,11.824,percent of total Billed Charges,62% of total Billed Charges,15.02,63,,12.016,percent of total billed charges,63% of total Billed Charges,14.78,62,,11.824,percent of total Billed Charges,62% of total Billed Charges,19.07,80,,15.256,percent of total Billed Charges,80% of Total Billed Charges,14.78,62,,11.824,percent of total Billed Charges,62% of total Billed Charges,14.78,62,,11.824,percent of total Billed Charges,62% of total Billed Charges,14.78,20.26,
BENEPROTEIN ORAL POWDER PACKET,70160,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,71717,CDM,270,RC,,,Outpatient,,,10.19,7.133,,8.15,80,,6.52,percent of total Billed Charges,80% of Total Billed Charges,6.42,63,,5.136,percent of total Billed charges,63% of Total Billed Charges,6.32,62,,5.056,percent of total Billed Charges,62% of total BIlled charges,6.42,63,,5.136,percent of total Billed Charges,63% of total Billed Charges,8.66,85,,6.928,percent of total Billed Charges,85% of total Billed Charges,8.15,80,,6.52,percent of total Billed Charges,80% of total Billed Charges,6.32,62,,5.056,percent of total Billed Charges,62% of total Billed Charges,6.42,63,,5.136,percent of total Billed Charges,63% of total Billed Charges,6.32,62,,5.056,percent of total Billed Charges,62% of total Billed Charges,6.42,63,,5.136,percent of total billed charges,63% of total Billed Charges,6.32,62,,5.056,percent of total Billed Charges,62% of total Billed Charges,8.15,80,,6.52,percent of total Billed Charges,80% of Total Billed Charges,6.32,62,,5.056,percent of total Billed Charges,62% of total Billed Charges,6.32,62,,5.056,percent of total Billed Charges,62% of total Billed Charges,6.32,8.66,
BENEPROTEIN ORAL POWDER PACKET,71890,CDM,270,RC,,,Outpatient,,,32.76,22.932,,26.21,80,,20.968,percent of total Billed Charges,80% of Total Billed Charges,20.64,63,,16.512,percent of total Billed charges,63% of Total Billed Charges,20.31,62,,16.248,percent of total Billed Charges,62% of total BIlled charges,20.64,63,,16.512,percent of total Billed Charges,63% of total Billed Charges,27.85,85,,22.28,percent of total Billed Charges,85% of total Billed Charges,26.21,80,,20.968,percent of total Billed Charges,80% of total Billed Charges,20.31,62,,16.248,percent of total Billed Charges,62% of total Billed Charges,20.64,63,,16.512,percent of total Billed Charges,63% of total Billed Charges,20.31,62,,16.248,percent of total Billed Charges,62% of total Billed Charges,20.64,63,,16.512,percent of total billed charges,63% of total Billed Charges,20.31,62,,16.248,percent of total Billed Charges,62% of total Billed Charges,26.21,80,,20.968,percent of total Billed Charges,80% of Total Billed Charges,20.31,62,,16.248,percent of total Billed Charges,62% of total Billed Charges,20.31,62,,16.248,percent of total Billed Charges,62% of total Billed Charges,20.31,27.85,
BENEPROTEIN ORAL POWDER PACKET,70548,CDM,270,RC,,,Outpatient,,,30.24,21.168,,24.19,80,,19.352,percent of total Billed Charges,80% of Total Billed Charges,19.05,63,,15.24,percent of total Billed charges,63% of Total Billed Charges,18.75,62,,15,percent of total Billed Charges,62% of total BIlled charges,19.05,63,,15.24,percent of total Billed Charges,63% of total Billed Charges,25.7,85,,20.56,percent of total Billed Charges,85% of total Billed Charges,24.19,80,,19.352,percent of total Billed Charges,80% of total Billed Charges,18.75,62,,15,percent of total Billed Charges,62% of total Billed Charges,19.05,63,,15.24,percent of total Billed Charges,63% of total Billed Charges,18.75,62,,15,percent of total Billed Charges,62% of total Billed Charges,19.05,63,,15.24,percent of total billed charges,63% of total Billed Charges,18.75,62,,15,percent of total Billed Charges,62% of total Billed Charges,24.19,80,,19.352,percent of total Billed Charges,80% of Total Billed Charges,18.75,62,,15,percent of total Billed Charges,62% of total Billed Charges,18.75,62,,15,percent of total Billed Charges,62% of total Billed Charges,18.75,25.7,
BENEPROTEIN ORAL POWDER PACKET,70161,CDM,270,RC,,,Outpatient,,,6.86,4.802,,5.49,80,,4.392,percent of total Billed Charges,80% of Total Billed Charges,4.32,63,,3.456,percent of total Billed charges,63% of Total Billed Charges,4.25,62,,3.4,percent of total Billed Charges,62% of total BIlled charges,4.32,63,,3.456,percent of total Billed Charges,63% of total Billed Charges,5.83,85,,4.664,percent of total Billed Charges,85% of total Billed Charges,5.49,80,,4.392,percent of total Billed Charges,80% of total Billed Charges,4.25,62,,3.4,percent of total Billed Charges,62% of total Billed Charges,4.32,63,,3.456,percent of total Billed Charges,63% of total Billed Charges,4.25,62,,3.4,percent of total Billed Charges,62% of total Billed Charges,4.32,63,,3.456,percent of total billed charges,63% of total Billed Charges,4.25,62,,3.4,percent of total Billed Charges,62% of total Billed Charges,5.49,80,,4.392,percent of total Billed Charges,80% of Total Billed Charges,4.25,62,,3.4,percent of total Billed Charges,62% of total Billed Charges,4.25,62,,3.4,percent of total Billed Charges,62% of total Billed Charges,4.25,5.83,
BENEPROTEIN ORAL POWDER PACKET,72346,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,70163,CDM,270,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
BENEPROTEIN ORAL POWDER PACKET,72081,CDM,270,RC,,,Outpatient,,,10,7,,8,80,,6.4,percent of total Billed Charges,80% of Total Billed Charges,6.3,63,,5.04,percent of total Billed charges,63% of Total Billed Charges,6.2,62,,4.96,percent of total Billed Charges,62% of total BIlled charges,6.3,63,,5.04,percent of total Billed Charges,63% of total Billed Charges,8.5,85,,6.8,percent of total Billed Charges,85% of total Billed Charges,8,80,,6.4,percent of total Billed Charges,80% of total Billed Charges,6.2,62,,4.96,percent of total Billed Charges,62% of total Billed Charges,6.3,63,,5.04,percent of total Billed Charges,63% of total Billed Charges,6.2,62,,4.96,percent of total Billed Charges,62% of total Billed Charges,6.3,63,,5.04,percent of total billed charges,63% of total Billed Charges,6.2,62,,4.96,percent of total Billed Charges,62% of total Billed Charges,8,80,,6.4,percent of total Billed Charges,80% of Total Billed Charges,6.2,62,,4.96,percent of total Billed Charges,62% of total Billed Charges,6.2,62,,4.96,percent of total Billed Charges,62% of total Billed Charges,6.2,8.5,
BENEPROTEIN ORAL POWDER PACKET,70660,CDM,270,RC,,,Outpatient,,,202.5,141.75,,162,80,,129.6,percent of total Billed Charges,80% of Total Billed Charges,127.58,63,,102.064,percent of total Billed charges,63% of Total Billed Charges,125.55,62,,100.44,percent of total Billed Charges,62% of total BIlled charges,127.58,63,,102.064,percent of total Billed Charges,63% of total Billed Charges,172.13,85,,137.704,percent of total Billed Charges,85% of total Billed Charges,162,80,,129.6,percent of total Billed Charges,80% of total Billed Charges,125.55,62,,100.44,percent of total Billed Charges,62% of total Billed Charges,127.58,63,,102.064,percent of total Billed Charges,63% of total Billed Charges,125.55,62,,100.44,percent of total Billed Charges,62% of total Billed Charges,127.58,63,,102.064,percent of total billed charges,63% of total Billed Charges,125.55,62,,100.44,percent of total Billed Charges,62% of total Billed Charges,162,80,,129.6,percent of total Billed Charges,80% of Total Billed Charges,125.55,62,,100.44,percent of total Billed Charges,62% of total Billed Charges,125.55,62,,100.44,percent of total Billed Charges,62% of total Billed Charges,125.55,172.13,
BENEPROTEIN ORAL POWDER PACKET,72079,CDM,270,RC,,,Outpatient,,,27.37,19.159,,21.9,80,,17.52,percent of total Billed Charges,80% of Total Billed Charges,17.24,63,,13.792,percent of total Billed charges,63% of Total Billed Charges,16.97,62,,13.576,percent of total Billed Charges,62% of total BIlled charges,17.24,63,,13.792,percent of total Billed Charges,63% of total Billed Charges,23.26,85,,18.608,percent of total Billed Charges,85% of total Billed Charges,21.9,80,,17.52,percent of total Billed Charges,80% of total Billed Charges,16.97,62,,13.576,percent of total Billed Charges,62% of total Billed Charges,17.24,63,,13.792,percent of total Billed Charges,63% of total Billed Charges,16.97,62,,13.576,percent of total Billed Charges,62% of total Billed Charges,17.24,63,,13.792,percent of total billed charges,63% of total Billed Charges,16.97,62,,13.576,percent of total Billed Charges,62% of total Billed Charges,21.9,80,,17.52,percent of total Billed Charges,80% of Total Billed Charges,16.97,62,,13.576,percent of total Billed Charges,62% of total Billed Charges,16.97,62,,13.576,percent of total Billed Charges,62% of total Billed Charges,16.97,23.26,
BENEPROTEIN ORAL POWDER PACKET,72084,CDM,270,RC,,,Outpatient,,,7.56,5.292,,6.05,80,,4.84,percent of total Billed Charges,80% of Total Billed Charges,4.76,63,,3.808,percent of total Billed charges,63% of Total Billed Charges,4.69,62,,3.752,percent of total Billed Charges,62% of total BIlled charges,4.76,63,,3.808,percent of total Billed Charges,63% of total Billed Charges,6.43,85,,5.144,percent of total Billed Charges,85% of total Billed Charges,6.05,80,,4.84,percent of total Billed Charges,80% of total Billed Charges,4.69,62,,3.752,percent of total Billed Charges,62% of total Billed Charges,4.76,63,,3.808,percent of total Billed Charges,63% of total Billed Charges,4.69,62,,3.752,percent of total Billed Charges,62% of total Billed Charges,4.76,63,,3.808,percent of total billed charges,63% of total Billed Charges,4.69,62,,3.752,percent of total Billed Charges,62% of total Billed Charges,6.05,80,,4.84,percent of total Billed Charges,80% of Total Billed Charges,4.69,62,,3.752,percent of total Billed Charges,62% of total Billed Charges,4.69,62,,3.752,percent of total Billed Charges,62% of total Billed Charges,4.69,6.43,
Imaging Mamography,70267,CDM,271,RC,,,Outpatient,,,27.76,19.432,,22.21,80,,17.768,percent of total Billed Charges,80% of Total Billed Charges,17.49,63,,13.992,percent of total Billed charges,63% of Total Billed Charges,17.21,62,,13.768,percent of total Billed Charges,62% of total BIlled charges,17.49,63,,13.992,percent of total Billed Charges,63% of total Billed Charges,23.6,85,,18.88,percent of total Billed Charges,85% of total Billed Charges,22.21,80,,17.768,percent of total Billed Charges,80% of total Billed Charges,17.21,62,,13.768,percent of total Billed Charges,62% of total Billed Charges,17.49,63,,13.992,percent of total Billed Charges,63% of total Billed Charges,17.21,62,,13.768,percent of total Billed Charges,62% of total Billed Charges,17.49,63,,13.992,percent of total billed charges,63% of total Billed Charges,17.21,62,,13.768,percent of total Billed Charges,62% of total Billed Charges,22.21,80,,17.768,percent of total Billed Charges,80% of Total Billed Charges,17.21,62,,13.768,percent of total Billed Charges,62% of total Billed Charges,17.21,62,,13.768,percent of total Billed Charges,62% of total Billed Charges,17.21,23.6,
Imaging Mamography,70207,CDM,271,RC,,,Outpatient,,,20.9,14.63,,16.72,80,,13.376,percent of total Billed Charges,80% of Total Billed Charges,13.17,63,,10.536,percent of total Billed charges,63% of Total Billed Charges,12.96,62,,10.368,percent of total Billed Charges,62% of total BIlled charges,13.17,63,,10.536,percent of total Billed Charges,63% of total Billed Charges,17.77,85,,14.216,percent of total Billed Charges,85% of total Billed Charges,16.72,80,,13.376,percent of total Billed Charges,80% of total Billed Charges,12.96,62,,10.368,percent of total Billed Charges,62% of total Billed Charges,13.17,63,,10.536,percent of total Billed Charges,63% of total Billed Charges,12.96,62,,10.368,percent of total Billed Charges,62% of total Billed Charges,13.17,63,,10.536,percent of total billed charges,63% of total Billed Charges,12.96,62,,10.368,percent of total Billed Charges,62% of total Billed Charges,16.72,80,,13.376,percent of total Billed Charges,80% of Total Billed Charges,12.96,62,,10.368,percent of total Billed Charges,62% of total Billed Charges,12.96,62,,10.368,percent of total Billed Charges,62% of total Billed Charges,12.96,17.77,
Imaging Mamography,70450,CDM,271,RC,,,Outpatient,,,25.45,17.815,,20.36,80,,16.288,percent of total Billed Charges,80% of Total Billed Charges,16.03,63,,12.824,percent of total Billed charges,63% of Total Billed Charges,15.78,62,,12.624,percent of total Billed Charges,62% of total BIlled charges,16.03,63,,12.824,percent of total Billed Charges,63% of total Billed Charges,21.63,85,,17.304,percent of total Billed Charges,85% of total Billed Charges,20.36,80,,16.288,percent of total Billed Charges,80% of total Billed Charges,15.78,62,,12.624,percent of total Billed Charges,62% of total Billed Charges,16.03,63,,12.824,percent of total Billed Charges,63% of total Billed Charges,15.78,62,,12.624,percent of total Billed Charges,62% of total Billed Charges,16.03,63,,12.824,percent of total billed charges,63% of total Billed Charges,15.78,62,,12.624,percent of total Billed Charges,62% of total Billed Charges,20.36,80,,16.288,percent of total Billed Charges,80% of Total Billed Charges,15.78,62,,12.624,percent of total Billed Charges,62% of total Billed Charges,15.78,62,,12.624,percent of total Billed Charges,62% of total Billed Charges,15.78,21.63,
WLMH Coban Sterile,71664,CDM,272,RC,,,Outpatient,,,10,7,,8,80,,6.4,percent of total Billed Charges,80% of Total Billed Charges,6.3,63,,5.04,percent of total Billed charges,63% of Total Billed Charges,6.2,62,,4.96,percent of total Billed Charges,62% of total BIlled charges,6.3,63,,5.04,percent of total Billed Charges,63% of total Billed Charges,8.5,85,,6.8,percent of total Billed Charges,85% of total Billed Charges,8,80,,6.4,percent of total Billed Charges,80% of total Billed Charges,6.2,62,,4.96,percent of total Billed Charges,62% of total Billed Charges,6.3,63,,5.04,percent of total Billed Charges,63% of total Billed Charges,6.2,62,,4.96,percent of total Billed Charges,62% of total Billed Charges,6.3,63,,5.04,percent of total billed charges,63% of total Billed Charges,6.2,62,,4.96,percent of total Billed Charges,62% of total Billed Charges,8,80,,6.4,percent of total Billed Charges,80% of Total Billed Charges,6.2,62,,4.96,percent of total Billed Charges,62% of total Billed Charges,6.2,62,,4.96,percent of total Billed Charges,62% of total Billed Charges,6.2,8.5,
WLMH Gastrografin,170047,CDM,272,RC,,,Outpatient,,,31,21.7,,24.8,80,,19.84,percent of total Billed Charges,80% of Total Billed Charges,19.53,63,,15.624,percent of total Billed charges,63% of Total Billed Charges,19.22,62,,15.376,percent of total Billed Charges,62% of total BIlled charges,19.53,63,,15.624,percent of total Billed Charges,63% of total Billed Charges,26.35,85,,21.08,percent of total Billed Charges,85% of total Billed Charges,24.8,80,,19.84,percent of total Billed Charges,80% of total Billed Charges,19.22,62,,15.376,percent of total Billed Charges,62% of total Billed Charges,19.53,63,,15.624,percent of total Billed Charges,63% of total Billed Charges,19.22,62,,15.376,percent of total Billed Charges,62% of total Billed Charges,19.53,63,,15.624,percent of total billed charges,63% of total Billed Charges,19.22,62,,15.376,percent of total Billed Charges,62% of total Billed Charges,24.8,80,,19.84,percent of total Billed Charges,80% of Total Billed Charges,19.22,62,,15.376,percent of total Billed Charges,62% of total Billed Charges,19.22,62,,15.376,percent of total Billed Charges,62% of total Billed Charges,19.22,26.35,
WLMH IV Cath 18 x 1 1/4,70837,CDM,272,RC,,,Outpatient,,,8,5.6,,6.4,80,,5.12,percent of total Billed Charges,80% of Total Billed Charges,5.04,63,,4.032,percent of total Billed charges,63% of Total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total BIlled charges,5.04,63,,4.032,percent of total Billed Charges,63% of total Billed Charges,6.8,85,,5.44,percent of total Billed Charges,85% of total Billed Charges,6.4,80,,5.12,percent of total Billed Charges,80% of total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,5.04,63,,4.032,percent of total Billed Charges,63% of total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,5.04,63,,4.032,percent of total billed charges,63% of total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,6.4,80,,5.12,percent of total Billed Charges,80% of Total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,4.96,6.8,
WLMH IV Cath 20 x 1 1/4,70835,CDM,272,RC,,,Outpatient,,,8,5.6,,6.4,80,,5.12,percent of total Billed Charges,80% of Total Billed Charges,5.04,63,,4.032,percent of total Billed charges,63% of Total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total BIlled charges,5.04,63,,4.032,percent of total Billed Charges,63% of total Billed Charges,6.8,85,,5.44,percent of total Billed Charges,85% of total Billed Charges,6.4,80,,5.12,percent of total Billed Charges,80% of total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,5.04,63,,4.032,percent of total Billed Charges,63% of total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,5.04,63,,4.032,percent of total billed charges,63% of total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,6.4,80,,5.12,percent of total Billed Charges,80% of Total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,4.96,6.8,
WLMH Isovue 370mgl/ml 100 ml,71860,CDM,272,RC,,,Outpatient,,,70,49,,56,80,,44.8,percent of total Billed Charges,80% of Total Billed Charges,44.1,63,,35.28,percent of total Billed charges,63% of Total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total BIlled charges,44.1,63,,35.28,percent of total Billed Charges,63% of total Billed Charges,59.5,85,,47.6,percent of total Billed Charges,85% of total Billed Charges,56,80,,44.8,percent of total Billed Charges,80% of total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total Billed Charges,44.1,63,,35.28,percent of total Billed Charges,63% of total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total Billed Charges,44.1,63,,35.28,percent of total billed charges,63% of total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total Billed Charges,56,80,,44.8,percent of total Billed Charges,80% of Total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total Billed Charges,43.4,59.5,
WLMH Isovue 370mgl/ml 50 ml,71859,CDM,272,RC,,,Outpatient,,,37,25.9,,29.6,80,,23.68,percent of total Billed Charges,80% of Total Billed Charges,23.31,63,,18.648,percent of total Billed charges,63% of Total Billed Charges,22.94,62,,18.352,percent of total Billed Charges,62% of total BIlled charges,23.31,63,,18.648,percent of total Billed Charges,63% of total Billed Charges,31.45,85,,25.16,percent of total Billed Charges,85% of total Billed Charges,29.6,80,,23.68,percent of total Billed Charges,80% of total Billed Charges,22.94,62,,18.352,percent of total Billed Charges,62% of total Billed Charges,23.31,63,,18.648,percent of total Billed Charges,63% of total Billed Charges,22.94,62,,18.352,percent of total Billed Charges,62% of total Billed Charges,23.31,63,,18.648,percent of total billed charges,63% of total Billed Charges,22.94,62,,18.352,percent of total Billed Charges,62% of total Billed Charges,29.6,80,,23.68,percent of total Billed Charges,80% of Total Billed Charges,22.94,62,,18.352,percent of total Billed Charges,62% of total Billed Charges,22.94,62,,18.352,percent of total Billed Charges,62% of total Billed Charges,22.94,31.45,
WLMH Syringe Tri-PK MEDRAD,71844,CDM,272,RC,,,Outpatient,,,38,26.6,,30.4,80,,24.32,percent of total Billed Charges,80% of Total Billed Charges,23.94,63,,19.152,percent of total Billed charges,63% of Total Billed Charges,23.56,62,,18.848,percent of total Billed Charges,62% of total BIlled charges,23.94,63,,19.152,percent of total Billed Charges,63% of total Billed Charges,32.3,85,,25.84,percent of total Billed Charges,85% of total Billed Charges,30.4,80,,24.32,percent of total Billed Charges,80% of total Billed Charges,23.56,62,,18.848,percent of total Billed Charges,62% of total Billed Charges,23.94,63,,19.152,percent of total Billed Charges,63% of total Billed Charges,23.56,62,,18.848,percent of total Billed Charges,62% of total Billed Charges,23.94,63,,19.152,percent of total billed charges,63% of total Billed Charges,23.56,62,,18.848,percent of total Billed Charges,62% of total Billed Charges,30.4,80,,24.32,percent of total Billed Charges,80% of Total Billed Charges,23.56,62,,18.848,percent of total Billed Charges,62% of total Billed Charges,23.56,62,,18.848,percent of total Billed Charges,62% of total Billed Charges,23.56,32.3,
Medical/surgical sterile supply,70675,CDM,272,RC,,,Outpatient,,,9,6.3,,7.2,80,,5.76,percent of total Billed Charges,80% of Total Billed Charges,5.67,63,,4.536,percent of total Billed charges,63% of Total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total BIlled charges,5.67,63,,4.536,percent of total Billed Charges,63% of total Billed Charges,7.65,85,,6.12,percent of total Billed Charges,85% of total Billed Charges,7.2,80,,5.76,percent of total Billed Charges,80% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.67,63,,4.536,percent of total Billed Charges,63% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.67,63,,4.536,percent of total billed charges,63% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,7.2,80,,5.76,percent of total Billed Charges,80% of Total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.58,62,,4.464,percent of total Billed Charges,62% of total Billed Charges,5.58,7.65,
Medical/surgical sterile supply,72019,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70689,CDM,272,RC,,,Outpatient,,,10.43,7.301,,8.34,80,,6.672,percent of total Billed Charges,80% of Total Billed Charges,6.57,63,,5.256,percent of total Billed charges,63% of Total Billed Charges,6.47,62,,5.176,percent of total Billed Charges,62% of total BIlled charges,6.57,63,,5.256,percent of total Billed Charges,63% of total Billed Charges,8.87,85,,7.096,percent of total Billed Charges,85% of total Billed Charges,8.34,80,,6.672,percent of total Billed Charges,80% of total Billed Charges,6.47,62,,5.176,percent of total Billed Charges,62% of total Billed Charges,6.57,63,,5.256,percent of total Billed Charges,63% of total Billed Charges,6.47,62,,5.176,percent of total Billed Charges,62% of total Billed Charges,6.57,63,,5.256,percent of total billed charges,63% of total Billed Charges,6.47,62,,5.176,percent of total Billed Charges,62% of total Billed Charges,8.34,80,,6.672,percent of total Billed Charges,80% of Total Billed Charges,6.47,62,,5.176,percent of total Billed Charges,62% of total Billed Charges,6.47,62,,5.176,percent of total Billed Charges,62% of total Billed Charges,6.47,8.87,
Medical/surgical sterile supply,72023,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70663,CDM,272,RC,,,Outpatient,,,6.76,4.732,,5.41,80,,4.328,percent of total Billed Charges,80% of Total Billed Charges,4.26,63,,3.408,percent of total Billed charges,63% of Total Billed Charges,4.19,62,,3.352,percent of total Billed Charges,62% of total BIlled charges,4.26,63,,3.408,percent of total Billed Charges,63% of total Billed Charges,5.75,85,,4.6,percent of total Billed Charges,85% of total Billed Charges,5.41,80,,4.328,percent of total Billed Charges,80% of total Billed Charges,4.19,62,,3.352,percent of total Billed Charges,62% of total Billed Charges,4.26,63,,3.408,percent of total Billed Charges,63% of total Billed Charges,4.19,62,,3.352,percent of total Billed Charges,62% of total Billed Charges,4.26,63,,3.408,percent of total billed charges,63% of total Billed Charges,4.19,62,,3.352,percent of total Billed Charges,62% of total Billed Charges,5.41,80,,4.328,percent of total Billed Charges,80% of Total Billed Charges,4.19,62,,3.352,percent of total Billed Charges,62% of total Billed Charges,4.19,62,,3.352,percent of total Billed Charges,62% of total Billed Charges,4.19,5.75,
Medical/surgical sterile supply,71556,CDM,272,RC,,,Outpatient,,,8.79,6.153,,7.03,80,,5.624,percent of total Billed Charges,80% of Total Billed Charges,5.54,63,,4.432,percent of total Billed charges,63% of Total Billed Charges,5.45,62,,4.36,percent of total Billed Charges,62% of total BIlled charges,5.54,63,,4.432,percent of total Billed Charges,63% of total Billed Charges,7.47,85,,5.976,percent of total Billed Charges,85% of total Billed Charges,7.03,80,,5.624,percent of total Billed Charges,80% of total Billed Charges,5.45,62,,4.36,percent of total Billed Charges,62% of total Billed Charges,5.54,63,,4.432,percent of total Billed Charges,63% of total Billed Charges,5.45,62,,4.36,percent of total Billed Charges,62% of total Billed Charges,5.54,63,,4.432,percent of total billed charges,63% of total Billed Charges,5.45,62,,4.36,percent of total Billed Charges,62% of total Billed Charges,7.03,80,,5.624,percent of total Billed Charges,80% of Total Billed Charges,5.45,62,,4.36,percent of total Billed Charges,62% of total Billed Charges,5.45,62,,4.36,percent of total Billed Charges,62% of total Billed Charges,5.45,7.47,
Medical/surgical sterile supply,50174,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,71618,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70230,CDM,272,RC,,,Outpatient,,,8.5,5.95,,6.8,80,,5.44,percent of total Billed Charges,80% of Total Billed Charges,5.36,63,,4.288,percent of total Billed charges,63% of Total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total BIlled charges,5.36,63,,4.288,percent of total Billed Charges,63% of total Billed Charges,7.23,85,,5.784,percent of total Billed Charges,85% of total Billed Charges,6.8,80,,5.44,percent of total Billed Charges,80% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.36,63,,4.288,percent of total Billed Charges,63% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.36,63,,4.288,percent of total billed charges,63% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,6.8,80,,5.44,percent of total Billed Charges,80% of Total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.27,7.23,
Medical/surgical sterile supply,71543,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72016,CDM,272,RC,,,Outpatient,,,13.5,9.45,,10.8,80,,8.64,percent of total Billed Charges,80% of Total Billed Charges,8.51,63,,6.808,percent of total Billed charges,63% of Total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total BIlled charges,8.51,63,,6.808,percent of total Billed Charges,63% of total Billed Charges,11.48,85,,9.184,percent of total Billed Charges,85% of total Billed Charges,10.8,80,,8.64,percent of total Billed Charges,80% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.51,63,,6.808,percent of total Billed Charges,63% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.51,63,,6.808,percent of total billed charges,63% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,10.8,80,,8.64,percent of total Billed Charges,80% of Total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.37,11.48,
Medical/surgical sterile supply,70656,CDM,272,RC,,,Outpatient,,,7.5,5.25,,6,80,,4.8,percent of total Billed Charges,80% of Total Billed Charges,4.73,63,,3.784,percent of total Billed charges,63% of Total Billed Charges,4.65,62,,3.72,percent of total Billed Charges,62% of total BIlled charges,4.73,63,,3.784,percent of total Billed Charges,63% of total Billed Charges,6.38,85,,5.104,percent of total Billed Charges,85% of total Billed Charges,6,80,,4.8,percent of total Billed Charges,80% of total Billed Charges,4.65,62,,3.72,percent of total Billed Charges,62% of total Billed Charges,4.73,63,,3.784,percent of total Billed Charges,63% of total Billed Charges,4.65,62,,3.72,percent of total Billed Charges,62% of total Billed Charges,4.73,63,,3.784,percent of total billed charges,63% of total Billed Charges,4.65,62,,3.72,percent of total Billed Charges,62% of total Billed Charges,6,80,,4.8,percent of total Billed Charges,80% of Total Billed Charges,4.65,62,,3.72,percent of total Billed Charges,62% of total Billed Charges,4.65,62,,3.72,percent of total Billed Charges,62% of total Billed Charges,4.65,6.38,
Medical/surgical sterile supply,70217,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,50173,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70473,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72334,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,50171,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,71517,CDM,272,RC,,,Outpatient,,,6.5,4.55,,5.2,80,,4.16,percent of total Billed Charges,80% of Total Billed Charges,4.1,63,,3.28,percent of total Billed charges,63% of Total Billed Charges,4.03,62,,3.224,percent of total Billed Charges,62% of total BIlled charges,4.1,63,,3.28,percent of total Billed Charges,63% of total Billed Charges,5.53,85,,4.424,percent of total Billed Charges,85% of total Billed Charges,5.2,80,,4.16,percent of total Billed Charges,80% of total Billed Charges,4.03,62,,3.224,percent of total Billed Charges,62% of total Billed Charges,4.1,63,,3.28,percent of total Billed Charges,63% of total Billed Charges,4.03,62,,3.224,percent of total Billed Charges,62% of total Billed Charges,4.1,63,,3.28,percent of total billed charges,63% of total Billed Charges,4.03,62,,3.224,percent of total Billed Charges,62% of total Billed Charges,5.2,80,,4.16,percent of total Billed Charges,80% of Total Billed Charges,4.03,62,,3.224,percent of total Billed Charges,62% of total Billed Charges,4.03,62,,3.224,percent of total Billed Charges,62% of total Billed Charges,4.03,5.53,
Medical/surgical sterile supply,70187,CDM,272,RC,,,Outpatient,,,8.5,5.95,,6.8,80,,5.44,percent of total Billed Charges,80% of Total Billed Charges,5.36,63,,4.288,percent of total Billed charges,63% of Total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total BIlled charges,5.36,63,,4.288,percent of total Billed Charges,63% of total Billed Charges,7.23,85,,5.784,percent of total Billed Charges,85% of total Billed Charges,6.8,80,,5.44,percent of total Billed Charges,80% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.36,63,,4.288,percent of total Billed Charges,63% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.36,63,,4.288,percent of total billed charges,63% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,6.8,80,,5.44,percent of total Billed Charges,80% of Total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.27,7.23,
Medical/surgical sterile supply,71513,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,71115,CDM,272,RC,,,Outpatient,,,33.92,23.744,,27.14,80,,21.712,percent of total Billed Charges,80% of Total Billed Charges,21.37,63,,17.096,percent of total Billed charges,63% of Total Billed Charges,21.03,62,,16.824,percent of total Billed Charges,62% of total BIlled charges,21.37,63,,17.096,percent of total Billed Charges,63% of total Billed Charges,28.83,85,,23.064,percent of total Billed Charges,85% of total Billed Charges,27.14,80,,21.712,percent of total Billed Charges,80% of total Billed Charges,21.03,62,,16.824,percent of total Billed Charges,62% of total Billed Charges,21.37,63,,17.096,percent of total Billed Charges,63% of total Billed Charges,21.03,62,,16.824,percent of total Billed Charges,62% of total Billed Charges,21.37,63,,17.096,percent of total billed charges,63% of total Billed Charges,21.03,62,,16.824,percent of total Billed Charges,62% of total Billed Charges,27.14,80,,21.712,percent of total Billed Charges,80% of Total Billed Charges,21.03,62,,16.824,percent of total Billed Charges,62% of total Billed Charges,21.03,62,,16.824,percent of total Billed Charges,62% of total Billed Charges,21.03,28.83,
Medical/surgical sterile supply,71101,CDM,272,RC,,,Outpatient,,,13.23,9.261,,10.58,80,,8.464,percent of total Billed Charges,80% of Total Billed Charges,8.33,63,,6.664,percent of total Billed charges,63% of Total Billed Charges,8.2,62,,6.56,percent of total Billed Charges,62% of total BIlled charges,8.33,63,,6.664,percent of total Billed Charges,63% of total Billed Charges,11.25,85,,9,percent of total Billed Charges,85% of total Billed Charges,10.58,80,,8.464,percent of total Billed Charges,80% of total Billed Charges,8.2,62,,6.56,percent of total Billed Charges,62% of total Billed Charges,8.33,63,,6.664,percent of total Billed Charges,63% of total Billed Charges,8.2,62,,6.56,percent of total Billed Charges,62% of total Billed Charges,8.33,63,,6.664,percent of total billed charges,63% of total Billed Charges,8.2,62,,6.56,percent of total Billed Charges,62% of total Billed Charges,10.58,80,,8.464,percent of total Billed Charges,80% of Total Billed Charges,8.2,62,,6.56,percent of total Billed Charges,62% of total Billed Charges,8.2,62,,6.56,percent of total Billed Charges,62% of total Billed Charges,8.2,11.25,
Medical/surgical sterile supply,70516,CDM,272,RC,,,Outpatient,,,7.43,5.201,,5.94,80,,4.752,percent of total Billed Charges,80% of Total Billed Charges,4.68,63,,3.744,percent of total Billed charges,63% of Total Billed Charges,4.61,62,,3.688,percent of total Billed Charges,62% of total BIlled charges,4.68,63,,3.744,percent of total Billed Charges,63% of total Billed Charges,6.32,85,,5.056,percent of total Billed Charges,85% of total Billed Charges,5.94,80,,4.752,percent of total Billed Charges,80% of total Billed Charges,4.61,62,,3.688,percent of total Billed Charges,62% of total Billed Charges,4.68,63,,3.744,percent of total Billed Charges,63% of total Billed Charges,4.61,62,,3.688,percent of total Billed Charges,62% of total Billed Charges,4.68,63,,3.744,percent of total billed charges,63% of total Billed Charges,4.61,62,,3.688,percent of total Billed Charges,62% of total Billed Charges,5.94,80,,4.752,percent of total Billed Charges,80% of Total Billed Charges,4.61,62,,3.688,percent of total Billed Charges,62% of total Billed Charges,4.61,62,,3.688,percent of total Billed Charges,62% of total Billed Charges,4.61,6.32,
Medical/surgical sterile supply,70486,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,71511,CDM,272,RC,,,Outpatient,,,6,4.2,,4.8,80,,3.84,percent of total Billed Charges,80% of Total Billed Charges,3.78,63,,3.024,percent of total Billed charges,63% of Total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total BIlled charges,3.78,63,,3.024,percent of total Billed Charges,63% of total Billed Charges,5.1,85,,4.08,percent of total Billed Charges,85% of total Billed Charges,4.8,80,,3.84,percent of total Billed Charges,80% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.78,63,,3.024,percent of total Billed Charges,63% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.78,63,,3.024,percent of total billed charges,63% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,4.8,80,,3.84,percent of total Billed Charges,80% of Total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.72,5.1,
Medical/surgical sterile supply,71558,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72138,CDM,272,RC,,,Outpatient,,,14.5,10.15,,11.6,80,,9.28,percent of total Billed Charges,80% of Total Billed Charges,9.14,63,,7.312,percent of total Billed charges,63% of Total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total BIlled charges,9.14,63,,7.312,percent of total Billed Charges,63% of total Billed Charges,12.33,85,,9.864,percent of total Billed Charges,85% of total Billed Charges,11.6,80,,9.28,percent of total Billed Charges,80% of total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total Billed Charges,9.14,63,,7.312,percent of total Billed Charges,63% of total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total Billed Charges,9.14,63,,7.312,percent of total billed charges,63% of total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total Billed Charges,11.6,80,,9.28,percent of total Billed Charges,80% of Total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total Billed Charges,8.99,12.33,
Medical/surgical sterile supply,50159,CDM,272,RC,,,Outpatient,,,27,18.9,,21.6,80,,17.28,percent of total Billed Charges,80% of Total Billed Charges,17.01,63,,13.608,percent of total Billed charges,63% of Total Billed Charges,16.74,62,,13.392,percent of total Billed Charges,62% of total BIlled charges,17.01,63,,13.608,percent of total Billed Charges,63% of total Billed Charges,22.95,85,,18.36,percent of total Billed Charges,85% of total Billed Charges,21.6,80,,17.28,percent of total Billed Charges,80% of total Billed Charges,16.74,62,,13.392,percent of total Billed Charges,62% of total Billed Charges,17.01,63,,13.608,percent of total Billed Charges,63% of total Billed Charges,16.74,62,,13.392,percent of total Billed Charges,62% of total Billed Charges,17.01,63,,13.608,percent of total billed charges,63% of total Billed Charges,16.74,62,,13.392,percent of total Billed Charges,62% of total Billed Charges,21.6,80,,17.28,percent of total Billed Charges,80% of Total Billed Charges,16.74,62,,13.392,percent of total Billed Charges,62% of total Billed Charges,16.74,62,,13.392,percent of total Billed Charges,62% of total Billed Charges,16.74,22.95,
Medical/surgical sterile supply,70517,CDM,272,RC,,,Outpatient,,,8,5.6,,6.4,80,,5.12,percent of total Billed Charges,80% of Total Billed Charges,5.04,63,,4.032,percent of total Billed charges,63% of Total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total BIlled charges,5.04,63,,4.032,percent of total Billed Charges,63% of total Billed Charges,6.8,85,,5.44,percent of total Billed Charges,85% of total Billed Charges,6.4,80,,5.12,percent of total Billed Charges,80% of total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,5.04,63,,4.032,percent of total Billed Charges,63% of total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,5.04,63,,4.032,percent of total billed charges,63% of total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,6.4,80,,5.12,percent of total Billed Charges,80% of Total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,4.96,6.8,
Medical/surgical sterile supply,70480,CDM,272,RC,,,Outpatient,,,8.86,6.202,,7.09,80,,5.672,percent of total Billed Charges,80% of Total Billed Charges,5.58,63,,4.464,percent of total Billed charges,63% of Total Billed Charges,5.49,62,,4.392,percent of total Billed Charges,62% of total BIlled charges,5.58,63,,4.464,percent of total Billed Charges,63% of total Billed Charges,7.53,85,,6.024,percent of total Billed Charges,85% of total Billed Charges,7.09,80,,5.672,percent of total Billed Charges,80% of total Billed Charges,5.49,62,,4.392,percent of total Billed Charges,62% of total Billed Charges,5.58,63,,4.464,percent of total Billed Charges,63% of total Billed Charges,5.49,62,,4.392,percent of total Billed Charges,62% of total Billed Charges,5.58,63,,4.464,percent of total billed charges,63% of total Billed Charges,5.49,62,,4.392,percent of total Billed Charges,62% of total Billed Charges,7.09,80,,5.672,percent of total Billed Charges,80% of Total Billed Charges,5.49,62,,4.392,percent of total Billed Charges,62% of total Billed Charges,5.49,62,,4.392,percent of total Billed Charges,62% of total Billed Charges,5.49,7.53,
Medical/surgical sterile supply,71654,CDM,272,RC,,,Outpatient,,,6,4.2,,4.8,80,,3.84,percent of total Billed Charges,80% of Total Billed Charges,3.78,63,,3.024,percent of total Billed charges,63% of Total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total BIlled charges,3.78,63,,3.024,percent of total Billed Charges,63% of total Billed Charges,5.1,85,,4.08,percent of total Billed Charges,85% of total Billed Charges,4.8,80,,3.84,percent of total Billed Charges,80% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.78,63,,3.024,percent of total Billed Charges,63% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.78,63,,3.024,percent of total billed charges,63% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,4.8,80,,3.84,percent of total Billed Charges,80% of Total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.72,5.1,
Medical/surgical sterile supply,70658,CDM,272,RC,,,Outpatient,,,14,9.8,,11.2,80,,8.96,percent of total Billed Charges,80% of Total Billed Charges,8.82,63,,7.056,percent of total Billed charges,63% of Total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total BIlled charges,8.82,63,,7.056,percent of total Billed Charges,63% of total Billed Charges,11.9,85,,9.52,percent of total Billed Charges,85% of total Billed Charges,11.2,80,,8.96,percent of total Billed Charges,80% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.82,63,,7.056,percent of total Billed Charges,63% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.82,63,,7.056,percent of total billed charges,63% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,11.2,80,,8.96,percent of total Billed Charges,80% of Total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.68,11.9,
Medical/surgical sterile supply,70659,CDM,272,RC,,,Outpatient,,,14,9.8,,11.2,80,,8.96,percent of total Billed Charges,80% of Total Billed Charges,8.82,63,,7.056,percent of total Billed charges,63% of Total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total BIlled charges,8.82,63,,7.056,percent of total Billed Charges,63% of total Billed Charges,11.9,85,,9.52,percent of total Billed Charges,85% of total Billed Charges,11.2,80,,8.96,percent of total Billed Charges,80% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.82,63,,7.056,percent of total Billed Charges,63% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.82,63,,7.056,percent of total billed charges,63% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,11.2,80,,8.96,percent of total Billed Charges,80% of Total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.68,11.9,
Medical/surgical sterile supply,71699,CDM,272,RC,,,Outpatient,,,50,35,,40,80,,32,percent of total Billed Charges,80% of Total Billed Charges,31.5,63,,25.2,percent of total Billed charges,63% of Total Billed Charges,31,62,,24.8,percent of total Billed Charges,62% of total BIlled charges,31.5,63,,25.2,percent of total Billed Charges,63% of total Billed Charges,42.5,85,,34,percent of total Billed Charges,85% of total Billed Charges,40,80,,32,percent of total Billed Charges,80% of total Billed Charges,31,62,,24.8,percent of total Billed Charges,62% of total Billed Charges,31.5,63,,25.2,percent of total Billed Charges,63% of total Billed Charges,31,62,,24.8,percent of total Billed Charges,62% of total Billed Charges,31.5,63,,25.2,percent of total billed charges,63% of total Billed Charges,31,62,,24.8,percent of total Billed Charges,62% of total Billed Charges,40,80,,32,percent of total Billed Charges,80% of Total Billed Charges,31,62,,24.8,percent of total Billed Charges,62% of total Billed Charges,31,62,,24.8,percent of total Billed Charges,62% of total Billed Charges,31,42.5,
Medical/surgical sterile supply,71857,CDM,272,RC,,,Outpatient,,,135.98,95.186,,108.78,80,,87.024,percent of total Billed Charges,80% of Total Billed Charges,85.67,63,,68.536,percent of total Billed charges,63% of Total Billed Charges,84.31,62,,67.448,percent of total Billed Charges,62% of total BIlled charges,85.67,63,,68.536,percent of total Billed Charges,63% of total Billed Charges,115.58,85,,92.464,percent of total Billed Charges,85% of total Billed Charges,108.78,80,,87.024,percent of total Billed Charges,80% of total Billed Charges,84.31,62,,67.448,percent of total Billed Charges,62% of total Billed Charges,85.67,63,,68.536,percent of total Billed Charges,63% of total Billed Charges,84.31,62,,67.448,percent of total Billed Charges,62% of total Billed Charges,85.67,63,,68.536,percent of total billed charges,63% of total Billed Charges,84.31,62,,67.448,percent of total Billed Charges,62% of total Billed Charges,108.78,80,,87.024,percent of total Billed Charges,80% of Total Billed Charges,84.31,62,,67.448,percent of total Billed Charges,62% of total Billed Charges,84.31,62,,67.448,percent of total Billed Charges,62% of total Billed Charges,84.31,115.58,
Medical/surgical sterile supply,CDM,CDM,272,RC,,,Outpatient,,,26.36,18.452,,21.09,80,,16.872,percent of total Billed Charges,80% of Total Billed Charges,16.61,63,,13.288,percent of total Billed charges,63% of Total Billed Charges,16.34,62,,13.072,percent of total Billed Charges,62% of total BIlled charges,16.61,63,,13.288,percent of total Billed Charges,63% of total Billed Charges,22.41,85,,17.928,percent of total Billed Charges,85% of total Billed Charges,21.09,80,,16.872,percent of total Billed Charges,80% of total Billed Charges,16.34,62,,13.072,percent of total Billed Charges,62% of total Billed Charges,16.61,63,,13.288,percent of total Billed Charges,63% of total Billed Charges,16.34,62,,13.072,percent of total Billed Charges,62% of total Billed Charges,16.61,63,,13.288,percent of total billed charges,63% of total Billed Charges,16.34,62,,13.072,percent of total Billed Charges,62% of total Billed Charges,21.09,80,,16.872,percent of total Billed Charges,80% of Total Billed Charges,16.34,62,,13.072,percent of total Billed Charges,62% of total Billed Charges,16.34,62,,13.072,percent of total Billed Charges,62% of total Billed Charges,16.34,22.41,
Medical/surgical sterile supply,72236,CDM,272,RC,,,Outpatient,,,12.95,9.065,,10.36,80,,8.288,percent of total Billed Charges,80% of Total Billed Charges,8.16,63,,6.528,percent of total Billed charges,63% of Total Billed Charges,8.03,62,,6.424,percent of total Billed Charges,62% of total BIlled charges,8.16,63,,6.528,percent of total Billed Charges,63% of total Billed Charges,11.01,85,,8.808,percent of total Billed Charges,85% of total Billed Charges,10.36,80,,8.288,percent of total Billed Charges,80% of total Billed Charges,8.03,62,,6.424,percent of total Billed Charges,62% of total Billed Charges,8.16,63,,6.528,percent of total Billed Charges,63% of total Billed Charges,8.03,62,,6.424,percent of total Billed Charges,62% of total Billed Charges,8.16,63,,6.528,percent of total billed charges,63% of total Billed Charges,8.03,62,,6.424,percent of total Billed Charges,62% of total Billed Charges,10.36,80,,8.288,percent of total Billed Charges,80% of Total Billed Charges,8.03,62,,6.424,percent of total Billed Charges,62% of total Billed Charges,8.03,62,,6.424,percent of total Billed Charges,62% of total Billed Charges,8.03,11.01,
Medical/surgical sterile supply,72237,CDM,272,RC,,,Outpatient,,,23.8,16.66,,19.04,80,,15.232,percent of total Billed Charges,80% of Total Billed Charges,14.99,63,,11.992,percent of total Billed charges,63% of Total Billed Charges,14.76,62,,11.808,percent of total Billed Charges,62% of total BIlled charges,14.99,63,,11.992,percent of total Billed Charges,63% of total Billed Charges,20.23,85,,16.184,percent of total Billed Charges,85% of total Billed Charges,19.04,80,,15.232,percent of total Billed Charges,80% of total Billed Charges,14.76,62,,11.808,percent of total Billed Charges,62% of total Billed Charges,14.99,63,,11.992,percent of total Billed Charges,63% of total Billed Charges,14.76,62,,11.808,percent of total Billed Charges,62% of total Billed Charges,14.99,63,,11.992,percent of total billed charges,63% of total Billed Charges,14.76,62,,11.808,percent of total Billed Charges,62% of total Billed Charges,19.04,80,,15.232,percent of total Billed Charges,80% of Total Billed Charges,14.76,62,,11.808,percent of total Billed Charges,62% of total Billed Charges,14.76,62,,11.808,percent of total Billed Charges,62% of total Billed Charges,14.76,20.23,
Medical/surgical sterile supply,72148,CDM,272,RC,,,Outpatient,,,9.67,6.769,,7.74,80,,6.192,percent of total Billed Charges,80% of Total Billed Charges,6.09,63,,4.872,percent of total Billed charges,63% of Total Billed Charges,6,62,,4.8,percent of total Billed Charges,62% of total BIlled charges,6.09,63,,4.872,percent of total Billed Charges,63% of total Billed Charges,8.22,85,,6.576,percent of total Billed Charges,85% of total Billed Charges,7.74,80,,6.192,percent of total Billed Charges,80% of total Billed Charges,6,62,,4.8,percent of total Billed Charges,62% of total Billed Charges,6.09,63,,4.872,percent of total Billed Charges,63% of total Billed Charges,6,62,,4.8,percent of total Billed Charges,62% of total Billed Charges,6.09,63,,4.872,percent of total billed charges,63% of total Billed Charges,6,62,,4.8,percent of total Billed Charges,62% of total Billed Charges,7.74,80,,6.192,percent of total Billed Charges,80% of Total Billed Charges,6,62,,4.8,percent of total Billed Charges,62% of total Billed Charges,6,62,,4.8,percent of total Billed Charges,62% of total Billed Charges,6,8.22,
Medical/surgical sterile supply,72147,CDM,272,RC,,,Outpatient,,,6.3,4.41,,5.04,80,,4.032,percent of total Billed Charges,80% of Total Billed Charges,3.97,63,,3.176,percent of total Billed charges,63% of Total Billed Charges,3.91,62,,3.128,percent of total Billed Charges,62% of total BIlled charges,3.97,63,,3.176,percent of total Billed Charges,63% of total Billed Charges,5.36,85,,4.288,percent of total Billed Charges,85% of total Billed Charges,5.04,80,,4.032,percent of total Billed Charges,80% of total Billed Charges,3.91,62,,3.128,percent of total Billed Charges,62% of total Billed Charges,3.97,63,,3.176,percent of total Billed Charges,63% of total Billed Charges,3.91,62,,3.128,percent of total Billed Charges,62% of total Billed Charges,3.97,63,,3.176,percent of total billed charges,63% of total Billed Charges,3.91,62,,3.128,percent of total Billed Charges,62% of total Billed Charges,5.04,80,,4.032,percent of total Billed Charges,80% of Total Billed Charges,3.91,62,,3.128,percent of total Billed Charges,62% of total Billed Charges,3.91,62,,3.128,percent of total Billed Charges,62% of total Billed Charges,3.91,5.36,
Medical/surgical sterile supply,72211,CDM,272,RC,,,Outpatient,,,58,40.6,,46.4,80,,37.12,percent of total Billed Charges,80% of Total Billed Charges,36.54,63,,29.232,percent of total Billed charges,63% of Total Billed Charges,35.96,62,,28.768,percent of total Billed Charges,62% of total BIlled charges,36.54,63,,29.232,percent of total Billed Charges,63% of total Billed Charges,49.3,85,,39.44,percent of total Billed Charges,85% of total Billed Charges,46.4,80,,37.12,percent of total Billed Charges,80% of total Billed Charges,35.96,62,,28.768,percent of total Billed Charges,62% of total Billed Charges,36.54,63,,29.232,percent of total Billed Charges,63% of total Billed Charges,35.96,62,,28.768,percent of total Billed Charges,62% of total Billed Charges,36.54,63,,29.232,percent of total billed charges,63% of total Billed Charges,35.96,62,,28.768,percent of total Billed Charges,62% of total Billed Charges,46.4,80,,37.12,percent of total Billed Charges,80% of Total Billed Charges,35.96,62,,28.768,percent of total Billed Charges,62% of total Billed Charges,35.96,62,,28.768,percent of total Billed Charges,62% of total Billed Charges,35.96,49.3,
Medical/surgical sterile supply,72212,CDM,272,RC,,,Outpatient,,,111.5,78.05,,89.2,80,,71.36,percent of total Billed Charges,80% of Total Billed Charges,70.25,63,,56.2,percent of total Billed charges,63% of Total Billed Charges,69.13,62,,55.304,percent of total Billed Charges,62% of total BIlled charges,70.25,63,,56.2,percent of total Billed Charges,63% of total Billed Charges,94.78,85,,75.824,percent of total Billed Charges,85% of total Billed Charges,89.2,80,,71.36,percent of total Billed Charges,80% of total Billed Charges,69.13,62,,55.304,percent of total Billed Charges,62% of total Billed Charges,70.25,63,,56.2,percent of total Billed Charges,63% of total Billed Charges,69.13,62,,55.304,percent of total Billed Charges,62% of total Billed Charges,70.25,63,,56.2,percent of total billed charges,63% of total Billed Charges,69.13,62,,55.304,percent of total Billed Charges,62% of total Billed Charges,89.2,80,,71.36,percent of total Billed Charges,80% of Total Billed Charges,69.13,62,,55.304,percent of total Billed Charges,62% of total Billed Charges,69.13,62,,55.304,percent of total Billed Charges,62% of total Billed Charges,69.13,94.78,
Medical/surgical sterile supply,71830,CDM,272,RC,,,Outpatient,,,548.35,383.845,,438.68,80,,350.944,percent of total Billed Charges,80% of Total Billed Charges,345.46,63,,276.368,percent of total Billed charges,63% of Total Billed Charges,339.98,62,,271.984,percent of total Billed Charges,62% of total BIlled charges,345.46,63,,276.368,percent of total Billed Charges,63% of total Billed Charges,466.1,85,,372.88,percent of total Billed Charges,85% of total Billed Charges,438.68,80,,350.944,percent of total Billed Charges,80% of total Billed Charges,339.98,62,,271.984,percent of total Billed Charges,62% of total Billed Charges,345.46,63,,276.368,percent of total Billed Charges,63% of total Billed Charges,339.98,62,,271.984,percent of total Billed Charges,62% of total Billed Charges,345.46,63,,276.368,percent of total billed charges,63% of total Billed Charges,339.98,62,,271.984,percent of total Billed Charges,62% of total Billed Charges,438.68,80,,350.944,percent of total Billed Charges,80% of Total Billed Charges,339.98,62,,271.984,percent of total Billed Charges,62% of total Billed Charges,339.98,62,,271.984,percent of total Billed Charges,62% of total Billed Charges,339.98,466.1,
Medical/surgical sterile supply,71831,CDM,272,RC,,,Outpatient,,,548.35,383.845,,438.68,80,,350.944,percent of total Billed Charges,80% of Total Billed Charges,345.46,63,,276.368,percent of total Billed charges,63% of Total Billed Charges,339.98,62,,271.984,percent of total Billed Charges,62% of total BIlled charges,345.46,63,,276.368,percent of total Billed Charges,63% of total Billed Charges,466.1,85,,372.88,percent of total Billed Charges,85% of total Billed Charges,438.68,80,,350.944,percent of total Billed Charges,80% of total Billed Charges,339.98,62,,271.984,percent of total Billed Charges,62% of total Billed Charges,345.46,63,,276.368,percent of total Billed Charges,63% of total Billed Charges,339.98,62,,271.984,percent of total Billed Charges,62% of total Billed Charges,345.46,63,,276.368,percent of total billed charges,63% of total Billed Charges,339.98,62,,271.984,percent of total Billed Charges,62% of total Billed Charges,438.68,80,,350.944,percent of total Billed Charges,80% of Total Billed Charges,339.98,62,,271.984,percent of total Billed Charges,62% of total Billed Charges,339.98,62,,271.984,percent of total Billed Charges,62% of total Billed Charges,339.98,466.1,
Medical/surgical sterile supply,71832,CDM,272,RC,,,Outpatient,,,548.5,383.95,,438.8,80,,351.04,percent of total Billed Charges,80% of Total Billed Charges,345.56,63,,276.448,percent of total Billed charges,63% of Total Billed Charges,340.07,62,,272.056,percent of total Billed Charges,62% of total BIlled charges,345.56,63,,276.448,percent of total Billed Charges,63% of total Billed Charges,466.23,85,,372.984,percent of total Billed Charges,85% of total Billed Charges,438.8,80,,351.04,percent of total Billed Charges,80% of total Billed Charges,340.07,62,,272.056,percent of total Billed Charges,62% of total Billed Charges,345.56,63,,276.448,percent of total Billed Charges,63% of total Billed Charges,340.07,62,,272.056,percent of total Billed Charges,62% of total Billed Charges,345.56,63,,276.448,percent of total billed charges,63% of total Billed Charges,340.07,62,,272.056,percent of total Billed Charges,62% of total Billed Charges,438.8,80,,351.04,percent of total Billed Charges,80% of Total Billed Charges,340.07,62,,272.056,percent of total Billed Charges,62% of total Billed Charges,340.07,62,,272.056,percent of total Billed Charges,62% of total Billed Charges,340.07,466.23,
Medical/surgical sterile supply,72041,CDM,272,RC,,,Outpatient,,,548.35,383.845,,438.68,80,,350.944,percent of total Billed Charges,80% of Total Billed Charges,345.46,63,,276.368,percent of total Billed charges,63% of Total Billed Charges,339.98,62,,271.984,percent of total Billed Charges,62% of total BIlled charges,345.46,63,,276.368,percent of total Billed Charges,63% of total Billed Charges,466.1,85,,372.88,percent of total Billed Charges,85% of total Billed Charges,438.68,80,,350.944,percent of total Billed Charges,80% of total Billed Charges,339.98,62,,271.984,percent of total Billed Charges,62% of total Billed Charges,345.46,63,,276.368,percent of total Billed Charges,63% of total Billed Charges,339.98,62,,271.984,percent of total Billed Charges,62% of total Billed Charges,345.46,63,,276.368,percent of total billed charges,63% of total Billed Charges,339.98,62,,271.984,percent of total Billed Charges,62% of total Billed Charges,438.68,80,,350.944,percent of total Billed Charges,80% of Total Billed Charges,339.98,62,,271.984,percent of total Billed Charges,62% of total Billed Charges,339.98,62,,271.984,percent of total Billed Charges,62% of total Billed Charges,339.98,466.1,
Medical/surgical sterile supply,71116,CDM,272,RC,,,Outpatient,,,20.48,14.336,,16.38,80,,13.104,percent of total Billed Charges,80% of Total Billed Charges,12.9,63,,10.32,percent of total Billed charges,63% of Total Billed Charges,12.7,62,,10.16,percent of total Billed Charges,62% of total BIlled charges,12.9,63,,10.32,percent of total Billed Charges,63% of total Billed Charges,17.41,85,,13.928,percent of total Billed Charges,85% of total Billed Charges,16.38,80,,13.104,percent of total Billed Charges,80% of total Billed Charges,12.7,62,,10.16,percent of total Billed Charges,62% of total Billed Charges,12.9,63,,10.32,percent of total Billed Charges,63% of total Billed Charges,12.7,62,,10.16,percent of total Billed Charges,62% of total Billed Charges,12.9,63,,10.32,percent of total billed charges,63% of total Billed Charges,12.7,62,,10.16,percent of total Billed Charges,62% of total Billed Charges,16.38,80,,13.104,percent of total Billed Charges,80% of Total Billed Charges,12.7,62,,10.16,percent of total Billed Charges,62% of total Billed Charges,12.7,62,,10.16,percent of total Billed Charges,62% of total Billed Charges,12.7,17.41,
Medical/surgical sterile supply,71901,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70877,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70878,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70879,CDM,272,RC,,,Outpatient,,,5.06,3.542,,4.05,80,,3.24,percent of total Billed Charges,80% of Total Billed Charges,3.19,63,,2.552,percent of total Billed charges,63% of Total Billed Charges,3.14,62,,2.512,percent of total Billed Charges,62% of total BIlled charges,3.19,63,,2.552,percent of total Billed Charges,63% of total Billed Charges,4.3,85,,3.44,percent of total Billed Charges,85% of total Billed Charges,4.05,80,,3.24,percent of total Billed Charges,80% of total Billed Charges,3.14,62,,2.512,percent of total Billed Charges,62% of total Billed Charges,3.19,63,,2.552,percent of total Billed Charges,63% of total Billed Charges,3.14,62,,2.512,percent of total Billed Charges,62% of total Billed Charges,3.19,63,,2.552,percent of total billed charges,63% of total Billed Charges,3.14,62,,2.512,percent of total Billed Charges,62% of total Billed Charges,4.05,80,,3.24,percent of total Billed Charges,80% of Total Billed Charges,3.14,62,,2.512,percent of total Billed Charges,62% of total Billed Charges,3.14,62,,2.512,percent of total Billed Charges,62% of total Billed Charges,3.14,4.3,
Medical/surgical sterile supply,50055,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72308,CDM,272,RC,,,Outpatient,,,30.67,21.469,,24.54,80,,19.632,percent of total Billed Charges,80% of Total Billed Charges,19.32,63,,15.456,percent of total Billed charges,63% of Total Billed Charges,19.02,62,,15.216,percent of total Billed Charges,62% of total BIlled charges,19.32,63,,15.456,percent of total Billed Charges,63% of total Billed Charges,26.07,85,,20.856,percent of total Billed Charges,85% of total Billed Charges,24.54,80,,19.632,percent of total Billed Charges,80% of total Billed Charges,19.02,62,,15.216,percent of total Billed Charges,62% of total Billed Charges,19.32,63,,15.456,percent of total Billed Charges,63% of total Billed Charges,19.02,62,,15.216,percent of total Billed Charges,62% of total Billed Charges,19.32,63,,15.456,percent of total billed charges,63% of total Billed Charges,19.02,62,,15.216,percent of total Billed Charges,62% of total Billed Charges,24.54,80,,19.632,percent of total Billed Charges,80% of Total Billed Charges,19.02,62,,15.216,percent of total Billed Charges,62% of total Billed Charges,19.02,62,,15.216,percent of total Billed Charges,62% of total Billed Charges,19.02,26.07,
Medical/surgical sterile supply,72135,CDM,272,RC,,,Outpatient,,,19.67,13.769,,15.74,80,,12.592,percent of total Billed Charges,80% of Total Billed Charges,12.39,63,,9.912,percent of total Billed charges,63% of Total Billed Charges,12.2,62,,9.76,percent of total Billed Charges,62% of total BIlled charges,12.39,63,,9.912,percent of total Billed Charges,63% of total Billed Charges,16.72,85,,13.376,percent of total Billed Charges,85% of total Billed Charges,15.74,80,,12.592,percent of total Billed Charges,80% of total Billed Charges,12.2,62,,9.76,percent of total Billed Charges,62% of total Billed Charges,12.39,63,,9.912,percent of total Billed Charges,63% of total Billed Charges,12.2,62,,9.76,percent of total Billed Charges,62% of total Billed Charges,12.39,63,,9.912,percent of total billed charges,63% of total Billed Charges,12.2,62,,9.76,percent of total Billed Charges,62% of total Billed Charges,15.74,80,,12.592,percent of total Billed Charges,80% of Total Billed Charges,12.2,62,,9.76,percent of total Billed Charges,62% of total Billed Charges,12.2,62,,9.76,percent of total Billed Charges,62% of total Billed Charges,12.2,16.72,
Medical/surgical sterile supply,71515,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72172,CDM,272,RC,,,Outpatient,,,21,14.7,,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.23,63,,10.584,percent of total Billed charges,63% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total BIlled charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,17.85,85,,14.28,percent of total Billed Charges,85% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total billed charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,17.85,
Medical/surgical sterile supply,72221,CDM,272,RC,,,Outpatient,,,14,9.8,,11.2,80,,8.96,percent of total Billed Charges,80% of Total Billed Charges,8.82,63,,7.056,percent of total Billed charges,63% of Total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total BIlled charges,8.82,63,,7.056,percent of total Billed Charges,63% of total Billed Charges,11.9,85,,9.52,percent of total Billed Charges,85% of total Billed Charges,11.2,80,,8.96,percent of total Billed Charges,80% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.82,63,,7.056,percent of total Billed Charges,63% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.82,63,,7.056,percent of total billed charges,63% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,11.2,80,,8.96,percent of total Billed Charges,80% of Total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.68,11.9,
Medical/surgical sterile supply,72165,CDM,272,RC,,,Outpatient,,,119.5,83.65,,95.6,80,,76.48,percent of total Billed Charges,80% of Total Billed Charges,75.29,63,,60.232,percent of total Billed charges,63% of Total Billed Charges,74.09,62,,59.272,percent of total Billed Charges,62% of total BIlled charges,75.29,63,,60.232,percent of total Billed Charges,63% of total Billed Charges,101.58,85,,81.264,percent of total Billed Charges,85% of total Billed Charges,95.6,80,,76.48,percent of total Billed Charges,80% of total Billed Charges,74.09,62,,59.272,percent of total Billed Charges,62% of total Billed Charges,75.29,63,,60.232,percent of total Billed Charges,63% of total Billed Charges,74.09,62,,59.272,percent of total Billed Charges,62% of total Billed Charges,75.29,63,,60.232,percent of total billed charges,63% of total Billed Charges,74.09,62,,59.272,percent of total Billed Charges,62% of total Billed Charges,95.6,80,,76.48,percent of total Billed Charges,80% of Total Billed Charges,74.09,62,,59.272,percent of total Billed Charges,62% of total Billed Charges,74.09,62,,59.272,percent of total Billed Charges,62% of total Billed Charges,74.09,101.58,
Medical/surgical sterile supply,72134,CDM,272,RC,,,Outpatient,,,77.53,54.271,,62.02,80,,49.616,percent of total Billed Charges,80% of Total Billed Charges,48.84,63,,39.072,percent of total Billed charges,63% of Total Billed Charges,48.07,62,,38.456,percent of total Billed Charges,62% of total BIlled charges,48.84,63,,39.072,percent of total Billed Charges,63% of total Billed Charges,65.9,85,,52.72,percent of total Billed Charges,85% of total Billed Charges,62.02,80,,49.616,percent of total Billed Charges,80% of total Billed Charges,48.07,62,,38.456,percent of total Billed Charges,62% of total Billed Charges,48.84,63,,39.072,percent of total Billed Charges,63% of total Billed Charges,48.07,62,,38.456,percent of total Billed Charges,62% of total Billed Charges,48.84,63,,39.072,percent of total billed charges,63% of total Billed Charges,48.07,62,,38.456,percent of total Billed Charges,62% of total Billed Charges,62.02,80,,49.616,percent of total Billed Charges,80% of Total Billed Charges,48.07,62,,38.456,percent of total Billed Charges,62% of total Billed Charges,48.07,62,,38.456,percent of total Billed Charges,62% of total Billed Charges,48.07,65.9,
Medical/surgical sterile supply,72136,CDM,272,RC,,,Outpatient,,,9.49,6.643,,7.59,80,,6.072,percent of total Billed Charges,80% of Total Billed Charges,5.98,63,,4.784,percent of total Billed charges,63% of Total Billed Charges,5.88,62,,4.704,percent of total Billed Charges,62% of total BIlled charges,5.98,63,,4.784,percent of total Billed Charges,63% of total Billed Charges,8.07,85,,6.456,percent of total Billed Charges,85% of total Billed Charges,7.59,80,,6.072,percent of total Billed Charges,80% of total Billed Charges,5.88,62,,4.704,percent of total Billed Charges,62% of total Billed Charges,5.98,63,,4.784,percent of total Billed Charges,63% of total Billed Charges,5.88,62,,4.704,percent of total Billed Charges,62% of total Billed Charges,5.98,63,,4.784,percent of total billed charges,63% of total Billed Charges,5.88,62,,4.704,percent of total Billed Charges,62% of total Billed Charges,7.59,80,,6.072,percent of total Billed Charges,80% of Total Billed Charges,5.88,62,,4.704,percent of total Billed Charges,62% of total Billed Charges,5.88,62,,4.704,percent of total Billed Charges,62% of total Billed Charges,5.88,8.07,
Medical/surgical sterile supply,72133,CDM,272,RC,,,Outpatient,,,44.77,31.339,,35.82,80,,28.656,percent of total Billed Charges,80% of Total Billed Charges,28.21,63,,22.568,percent of total Billed charges,63% of Total Billed Charges,27.76,62,,22.208,percent of total Billed Charges,62% of total BIlled charges,28.21,63,,22.568,percent of total Billed Charges,63% of total Billed Charges,38.05,85,,30.44,percent of total Billed Charges,85% of total Billed Charges,35.82,80,,28.656,percent of total Billed Charges,80% of total Billed Charges,27.76,62,,22.208,percent of total Billed Charges,62% of total Billed Charges,28.21,63,,22.568,percent of total Billed Charges,63% of total Billed Charges,27.76,62,,22.208,percent of total Billed Charges,62% of total Billed Charges,28.21,63,,22.568,percent of total billed charges,63% of total Billed Charges,27.76,62,,22.208,percent of total Billed Charges,62% of total Billed Charges,35.82,80,,28.656,percent of total Billed Charges,80% of Total Billed Charges,27.76,62,,22.208,percent of total Billed Charges,62% of total Billed Charges,27.76,62,,22.208,percent of total Billed Charges,62% of total Billed Charges,27.76,38.05,
Medical/surgical sterile supply,10081,CDM,272,RC,,,Outpatient,,,97.86,68.502,,78.29,80,,62.632,percent of total Billed Charges,80% of Total Billed Charges,61.65,63,,49.32,percent of total Billed charges,63% of Total Billed Charges,60.67,62,,48.536,percent of total Billed Charges,62% of total BIlled charges,61.65,63,,49.32,percent of total Billed Charges,63% of total Billed Charges,83.18,85,,66.544,percent of total Billed Charges,85% of total Billed Charges,78.29,80,,62.632,percent of total Billed Charges,80% of total Billed Charges,60.67,62,,48.536,percent of total Billed Charges,62% of total Billed Charges,61.65,63,,49.32,percent of total Billed Charges,63% of total Billed Charges,60.67,62,,48.536,percent of total Billed Charges,62% of total Billed Charges,61.65,63,,49.32,percent of total billed charges,63% of total Billed Charges,60.67,62,,48.536,percent of total Billed Charges,62% of total Billed Charges,78.29,80,,62.632,percent of total Billed Charges,80% of Total Billed Charges,60.67,62,,48.536,percent of total Billed Charges,62% of total Billed Charges,60.67,62,,48.536,percent of total Billed Charges,62% of total Billed Charges,60.67,83.18,
Medical/surgical sterile supply,72050,CDM,272,RC,,,Outpatient,,,5.81,4.067,,4.65,80,,3.72,percent of total Billed Charges,80% of Total Billed Charges,3.66,63,,2.928,percent of total Billed charges,63% of Total Billed Charges,3.6,62,,2.88,percent of total Billed Charges,62% of total BIlled charges,3.66,63,,2.928,percent of total Billed Charges,63% of total Billed Charges,4.94,85,,3.952,percent of total Billed Charges,85% of total Billed Charges,4.65,80,,3.72,percent of total Billed Charges,80% of total Billed Charges,3.6,62,,2.88,percent of total Billed Charges,62% of total Billed Charges,3.66,63,,2.928,percent of total Billed Charges,63% of total Billed Charges,3.6,62,,2.88,percent of total Billed Charges,62% of total Billed Charges,3.66,63,,2.928,percent of total billed charges,63% of total Billed Charges,3.6,62,,2.88,percent of total Billed Charges,62% of total Billed Charges,4.65,80,,3.72,percent of total Billed Charges,80% of Total Billed Charges,3.6,62,,2.88,percent of total Billed Charges,62% of total Billed Charges,3.6,62,,2.88,percent of total Billed Charges,62% of total Billed Charges,3.6,4.94,
Medical/surgical sterile supply,72181,CDM,272,RC,,,Outpatient,,,51.5,36.05,,41.2,80,,32.96,percent of total Billed Charges,80% of Total Billed Charges,32.45,63,,25.96,percent of total Billed charges,63% of Total Billed Charges,31.93,62,,25.544,percent of total Billed Charges,62% of total BIlled charges,32.45,63,,25.96,percent of total Billed Charges,63% of total Billed Charges,43.78,85,,35.024,percent of total Billed Charges,85% of total Billed Charges,41.2,80,,32.96,percent of total Billed Charges,80% of total Billed Charges,31.93,62,,25.544,percent of total Billed Charges,62% of total Billed Charges,32.45,63,,25.96,percent of total Billed Charges,63% of total Billed Charges,31.93,62,,25.544,percent of total Billed Charges,62% of total Billed Charges,32.45,63,,25.96,percent of total billed charges,63% of total Billed Charges,31.93,62,,25.544,percent of total Billed Charges,62% of total Billed Charges,41.2,80,,32.96,percent of total Billed Charges,80% of Total Billed Charges,31.93,62,,25.544,percent of total Billed Charges,62% of total Billed Charges,31.93,62,,25.544,percent of total Billed Charges,62% of total Billed Charges,31.93,43.78,
Medical/surgical sterile supply,72182,CDM,272,RC,,,Outpatient,,,51.5,36.05,,41.2,80,,32.96,percent of total Billed Charges,80% of Total Billed Charges,32.45,63,,25.96,percent of total Billed charges,63% of Total Billed Charges,31.93,62,,25.544,percent of total Billed Charges,62% of total BIlled charges,32.45,63,,25.96,percent of total Billed Charges,63% of total Billed Charges,43.78,85,,35.024,percent of total Billed Charges,85% of total Billed Charges,41.2,80,,32.96,percent of total Billed Charges,80% of total Billed Charges,31.93,62,,25.544,percent of total Billed Charges,62% of total Billed Charges,32.45,63,,25.96,percent of total Billed Charges,63% of total Billed Charges,31.93,62,,25.544,percent of total Billed Charges,62% of total Billed Charges,32.45,63,,25.96,percent of total billed charges,63% of total Billed Charges,31.93,62,,25.544,percent of total Billed Charges,62% of total Billed Charges,41.2,80,,32.96,percent of total Billed Charges,80% of Total Billed Charges,31.93,62,,25.544,percent of total Billed Charges,62% of total Billed Charges,31.93,62,,25.544,percent of total Billed Charges,62% of total Billed Charges,31.93,43.78,
Medical/surgical sterile supply,72183,CDM,272,RC,,,Outpatient,,,51.5,36.05,,41.2,80,,32.96,percent of total Billed Charges,80% of Total Billed Charges,32.45,63,,25.96,percent of total Billed charges,63% of Total Billed Charges,31.93,62,,25.544,percent of total Billed Charges,62% of total BIlled charges,32.45,63,,25.96,percent of total Billed Charges,63% of total Billed Charges,43.78,85,,35.024,percent of total Billed Charges,85% of total Billed Charges,41.2,80,,32.96,percent of total Billed Charges,80% of total Billed Charges,31.93,62,,25.544,percent of total Billed Charges,62% of total Billed Charges,32.45,63,,25.96,percent of total Billed Charges,63% of total Billed Charges,31.93,62,,25.544,percent of total Billed Charges,62% of total Billed Charges,32.45,63,,25.96,percent of total billed charges,63% of total Billed Charges,31.93,62,,25.544,percent of total Billed Charges,62% of total Billed Charges,41.2,80,,32.96,percent of total Billed Charges,80% of Total Billed Charges,31.93,62,,25.544,percent of total Billed Charges,62% of total Billed Charges,31.93,62,,25.544,percent of total Billed Charges,62% of total Billed Charges,31.93,43.78,
Medical/surgical sterile supply,72240,CDM,272,RC,,,Outpatient,,,641,448.7,,512.8,80,,410.24,percent of total Billed Charges,80% of Total Billed Charges,403.83,63,,323.064,percent of total Billed charges,63% of Total Billed Charges,397.42,62,,317.936,percent of total Billed Charges,62% of total BIlled charges,403.83,63,,323.064,percent of total Billed Charges,63% of total Billed Charges,544.85,85,,435.88,percent of total Billed Charges,85% of total Billed Charges,512.8,80,,410.24,percent of total Billed Charges,80% of total Billed Charges,397.42,62,,317.936,percent of total Billed Charges,62% of total Billed Charges,403.83,63,,323.064,percent of total Billed Charges,63% of total Billed Charges,397.42,62,,317.936,percent of total Billed Charges,62% of total Billed Charges,403.83,63,,323.064,percent of total billed charges,63% of total Billed Charges,397.42,62,,317.936,percent of total Billed Charges,62% of total Billed Charges,512.8,80,,410.24,percent of total Billed Charges,80% of Total Billed Charges,397.42,62,,317.936,percent of total Billed Charges,62% of total Billed Charges,397.42,62,,317.936,percent of total Billed Charges,62% of total Billed Charges,397.42,544.85,
Medical/surgical sterile supply,71862,CDM,272,RC,,,Outpatient,,,28.5,19.95,,22.8,80,,18.24,percent of total Billed Charges,80% of Total Billed Charges,17.96,63,,14.368,percent of total Billed charges,63% of Total Billed Charges,17.67,62,,14.136,percent of total Billed Charges,62% of total BIlled charges,17.96,63,,14.368,percent of total Billed Charges,63% of total Billed Charges,24.23,85,,19.384,percent of total Billed Charges,85% of total Billed Charges,22.8,80,,18.24,percent of total Billed Charges,80% of total Billed Charges,17.67,62,,14.136,percent of total Billed Charges,62% of total Billed Charges,17.96,63,,14.368,percent of total Billed Charges,63% of total Billed Charges,17.67,62,,14.136,percent of total Billed Charges,62% of total Billed Charges,17.96,63,,14.368,percent of total billed charges,63% of total Billed Charges,17.67,62,,14.136,percent of total Billed Charges,62% of total Billed Charges,22.8,80,,18.24,percent of total Billed Charges,80% of Total Billed Charges,17.67,62,,14.136,percent of total Billed Charges,62% of total Billed Charges,17.67,62,,14.136,percent of total Billed Charges,62% of total Billed Charges,17.67,24.23,
Medical/surgical sterile supply,72027,CDM,272,RC,,,Outpatient,,,20.76,14.532,,16.61,80,,13.288,percent of total Billed Charges,80% of Total Billed Charges,13.08,63,,10.464,percent of total Billed charges,63% of Total Billed Charges,12.87,62,,10.296,percent of total Billed Charges,62% of total BIlled charges,13.08,63,,10.464,percent of total Billed Charges,63% of total Billed Charges,17.65,85,,14.12,percent of total Billed Charges,85% of total Billed Charges,16.61,80,,13.288,percent of total Billed Charges,80% of total Billed Charges,12.87,62,,10.296,percent of total Billed Charges,62% of total Billed Charges,13.08,63,,10.464,percent of total Billed Charges,63% of total Billed Charges,12.87,62,,10.296,percent of total Billed Charges,62% of total Billed Charges,13.08,63,,10.464,percent of total billed charges,63% of total Billed Charges,12.87,62,,10.296,percent of total Billed Charges,62% of total Billed Charges,16.61,80,,13.288,percent of total Billed Charges,80% of Total Billed Charges,12.87,62,,10.296,percent of total Billed Charges,62% of total Billed Charges,12.87,62,,10.296,percent of total Billed Charges,62% of total Billed Charges,12.87,17.65,
Medical/surgical sterile supply,70782,CDM,272,RC,,,Outpatient,,,13.48,9.436,,10.78,80,,8.624,percent of total Billed Charges,80% of Total Billed Charges,8.49,63,,6.792,percent of total Billed charges,63% of Total Billed Charges,8.36,62,,6.688,percent of total Billed Charges,62% of total BIlled charges,8.49,63,,6.792,percent of total Billed Charges,63% of total Billed Charges,11.46,85,,9.168,percent of total Billed Charges,85% of total Billed Charges,10.78,80,,8.624,percent of total Billed Charges,80% of total Billed Charges,8.36,62,,6.688,percent of total Billed Charges,62% of total Billed Charges,8.49,63,,6.792,percent of total Billed Charges,63% of total Billed Charges,8.36,62,,6.688,percent of total Billed Charges,62% of total Billed Charges,8.49,63,,6.792,percent of total billed charges,63% of total Billed Charges,8.36,62,,6.688,percent of total Billed Charges,62% of total Billed Charges,10.78,80,,8.624,percent of total Billed Charges,80% of Total Billed Charges,8.36,62,,6.688,percent of total Billed Charges,62% of total Billed Charges,8.36,62,,6.688,percent of total Billed Charges,62% of total Billed Charges,8.36,11.46,
Medical/surgical sterile supply,71664,CDM,272,RC,,,Outpatient,,,11.87,8.309,,9.5,80,,7.6,percent of total Billed Charges,80% of Total Billed Charges,7.48,63,,5.984,percent of total Billed charges,63% of Total Billed Charges,7.36,62,,5.888,percent of total Billed Charges,62% of total BIlled charges,7.48,63,,5.984,percent of total Billed Charges,63% of total Billed Charges,10.09,85,,8.072,percent of total Billed Charges,85% of total Billed Charges,9.5,80,,7.6,percent of total Billed Charges,80% of total Billed Charges,7.36,62,,5.888,percent of total Billed Charges,62% of total Billed Charges,7.48,63,,5.984,percent of total Billed Charges,63% of total Billed Charges,7.36,62,,5.888,percent of total Billed Charges,62% of total Billed Charges,7.48,63,,5.984,percent of total billed charges,63% of total Billed Charges,7.36,62,,5.888,percent of total Billed Charges,62% of total Billed Charges,9.5,80,,7.6,percent of total Billed Charges,80% of Total Billed Charges,7.36,62,,5.888,percent of total Billed Charges,62% of total Billed Charges,7.36,62,,5.888,percent of total Billed Charges,62% of total Billed Charges,7.36,10.09,
Medical/surgical sterile supply,71107,CDM,272,RC,,,Outpatient,,,21,14.7,,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.23,63,,10.584,percent of total Billed charges,63% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total BIlled charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,17.85,85,,14.28,percent of total Billed Charges,85% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total billed charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,17.85,
Medical/surgical sterile supply,72322,CDM,272,RC,,,Outpatient,,,20.79,14.553,,16.63,80,,13.304,percent of total Billed Charges,80% of Total Billed Charges,13.1,63,,10.48,percent of total Billed charges,63% of Total Billed Charges,12.89,62,,10.312,percent of total Billed Charges,62% of total BIlled charges,13.1,63,,10.48,percent of total Billed Charges,63% of total Billed Charges,17.67,85,,14.136,percent of total Billed Charges,85% of total Billed Charges,16.63,80,,13.304,percent of total Billed Charges,80% of total Billed Charges,12.89,62,,10.312,percent of total Billed Charges,62% of total Billed Charges,13.1,63,,10.48,percent of total Billed Charges,63% of total Billed Charges,12.89,62,,10.312,percent of total Billed Charges,62% of total Billed Charges,13.1,63,,10.48,percent of total billed charges,63% of total Billed Charges,12.89,62,,10.312,percent of total Billed Charges,62% of total Billed Charges,16.63,80,,13.304,percent of total Billed Charges,80% of Total Billed Charges,12.89,62,,10.312,percent of total Billed Charges,62% of total Billed Charges,12.89,62,,10.312,percent of total Billed Charges,62% of total Billed Charges,12.89,17.67,
Medical/surgical sterile supply,72321,CDM,272,RC,,,Outpatient,,,6.69,4.683,,5.35,80,,4.28,percent of total Billed Charges,80% of Total Billed Charges,4.21,63,,3.368,percent of total Billed charges,63% of Total Billed Charges,4.15,62,,3.32,percent of total Billed Charges,62% of total BIlled charges,4.21,63,,3.368,percent of total Billed Charges,63% of total Billed Charges,5.69,85,,4.552,percent of total Billed Charges,85% of total Billed Charges,5.35,80,,4.28,percent of total Billed Charges,80% of total Billed Charges,4.15,62,,3.32,percent of total Billed Charges,62% of total Billed Charges,4.21,63,,3.368,percent of total Billed Charges,63% of total Billed Charges,4.15,62,,3.32,percent of total Billed Charges,62% of total Billed Charges,4.21,63,,3.368,percent of total billed charges,63% of total Billed Charges,4.15,62,,3.32,percent of total Billed Charges,62% of total Billed Charges,5.35,80,,4.28,percent of total Billed Charges,80% of Total Billed Charges,4.15,62,,3.32,percent of total Billed Charges,62% of total Billed Charges,4.15,62,,3.32,percent of total Billed Charges,62% of total Billed Charges,4.15,5.69,
Medical/surgical sterile supply,71650,CDM,272,RC,,,Outpatient,,,15.79,11.053,,12.63,80,,10.104,percent of total Billed Charges,80% of Total Billed Charges,9.95,63,,7.96,percent of total Billed charges,63% of Total Billed Charges,9.79,62,,7.832,percent of total Billed Charges,62% of total BIlled charges,9.95,63,,7.96,percent of total Billed Charges,63% of total Billed Charges,13.42,85,,10.736,percent of total Billed Charges,85% of total Billed Charges,12.63,80,,10.104,percent of total Billed Charges,80% of total Billed Charges,9.79,62,,7.832,percent of total Billed Charges,62% of total Billed Charges,9.95,63,,7.96,percent of total Billed Charges,63% of total Billed Charges,9.79,62,,7.832,percent of total Billed Charges,62% of total Billed Charges,9.95,63,,7.96,percent of total billed charges,63% of total Billed Charges,9.79,62,,7.832,percent of total Billed Charges,62% of total Billed Charges,12.63,80,,10.104,percent of total Billed Charges,80% of Total Billed Charges,9.79,62,,7.832,percent of total Billed Charges,62% of total Billed Charges,9.79,62,,7.832,percent of total Billed Charges,62% of total Billed Charges,9.79,13.42,
Medical/surgical sterile supply,72171,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,71102,CDM,272,RC,,,Outpatient,,,440,308,,352,80,,281.6,percent of total Billed Charges,80% of Total Billed Charges,277.2,63,,221.76,percent of total Billed charges,63% of Total Billed Charges,272.8,62,,218.24,percent of total Billed Charges,62% of total BIlled charges,277.2,63,,221.76,percent of total Billed Charges,63% of total Billed Charges,374,85,,299.2,percent of total Billed Charges,85% of total Billed Charges,352,80,,281.6,percent of total Billed Charges,80% of total Billed Charges,272.8,62,,218.24,percent of total Billed Charges,62% of total Billed Charges,277.2,63,,221.76,percent of total Billed Charges,63% of total Billed Charges,272.8,62,,218.24,percent of total Billed Charges,62% of total Billed Charges,277.2,63,,221.76,percent of total billed charges,63% of total Billed Charges,272.8,62,,218.24,percent of total Billed Charges,62% of total Billed Charges,352,80,,281.6,percent of total Billed Charges,80% of Total Billed Charges,272.8,62,,218.24,percent of total Billed Charges,62% of total Billed Charges,272.8,62,,218.24,percent of total Billed Charges,62% of total Billed Charges,272.8,374,
Medical/surgical sterile supply,71728,CDM,272,RC,,,Outpatient,,,513,359.1,,410.4,80,,328.32,percent of total Billed Charges,80% of Total Billed Charges,323.19,63,,258.552,percent of total Billed charges,63% of Total Billed Charges,318.06,62,,254.448,percent of total Billed Charges,62% of total BIlled charges,323.19,63,,258.552,percent of total Billed Charges,63% of total Billed Charges,436.05,85,,348.84,percent of total Billed Charges,85% of total Billed Charges,410.4,80,,328.32,percent of total Billed Charges,80% of total Billed Charges,318.06,62,,254.448,percent of total Billed Charges,62% of total Billed Charges,323.19,63,,258.552,percent of total Billed Charges,63% of total Billed Charges,318.06,62,,254.448,percent of total Billed Charges,62% of total Billed Charges,323.19,63,,258.552,percent of total billed charges,63% of total Billed Charges,318.06,62,,254.448,percent of total Billed Charges,62% of total Billed Charges,410.4,80,,328.32,percent of total Billed Charges,80% of Total Billed Charges,318.06,62,,254.448,percent of total Billed Charges,62% of total Billed Charges,318.06,62,,254.448,percent of total Billed Charges,62% of total Billed Charges,318.06,436.05,
Medical/surgical sterile supply,72324,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72323,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,160050,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72226,CDM,272,RC,,,Outpatient,,,134.94,94.458,,107.95,80,,86.36,percent of total Billed Charges,80% of Total Billed Charges,85.01,63,,68.008,percent of total Billed charges,63% of Total Billed Charges,83.66,62,,66.928,percent of total Billed Charges,62% of total BIlled charges,85.01,63,,68.008,percent of total Billed Charges,63% of total Billed Charges,114.7,85,,91.76,percent of total Billed Charges,85% of total Billed Charges,107.95,80,,86.36,percent of total Billed Charges,80% of total Billed Charges,83.66,62,,66.928,percent of total Billed Charges,62% of total Billed Charges,85.01,63,,68.008,percent of total Billed Charges,63% of total Billed Charges,83.66,62,,66.928,percent of total Billed Charges,62% of total Billed Charges,85.01,63,,68.008,percent of total billed charges,63% of total Billed Charges,83.66,62,,66.928,percent of total Billed Charges,62% of total Billed Charges,107.95,80,,86.36,percent of total Billed Charges,80% of Total Billed Charges,83.66,62,,66.928,percent of total Billed Charges,62% of total Billed Charges,83.66,62,,66.928,percent of total Billed Charges,62% of total Billed Charges,83.66,114.7,
Medical/surgical sterile supply,72170,CDM,272,RC,,,Outpatient,,,34,23.8,,27.2,80,,21.76,percent of total Billed Charges,80% of Total Billed Charges,21.42,63,,17.136,percent of total Billed charges,63% of Total Billed Charges,21.08,62,,16.864,percent of total Billed Charges,62% of total BIlled charges,21.42,63,,17.136,percent of total Billed Charges,63% of total Billed Charges,28.9,85,,23.12,percent of total Billed Charges,85% of total Billed Charges,27.2,80,,21.76,percent of total Billed Charges,80% of total Billed Charges,21.08,62,,16.864,percent of total Billed Charges,62% of total Billed Charges,21.42,63,,17.136,percent of total Billed Charges,63% of total Billed Charges,21.08,62,,16.864,percent of total Billed Charges,62% of total Billed Charges,21.42,63,,17.136,percent of total billed charges,63% of total Billed Charges,21.08,62,,16.864,percent of total Billed Charges,62% of total Billed Charges,27.2,80,,21.76,percent of total Billed Charges,80% of Total Billed Charges,21.08,62,,16.864,percent of total Billed Charges,62% of total Billed Charges,21.08,62,,16.864,percent of total Billed Charges,62% of total Billed Charges,21.08,28.9,
Medical/surgical sterile supply,72228,CDM,272,RC,,,Outpatient,,,160,112,,128,80,,102.4,percent of total Billed Charges,80% of Total Billed Charges,100.8,63,,80.64,percent of total Billed charges,63% of Total Billed Charges,99.2,62,,79.36,percent of total Billed Charges,62% of total BIlled charges,100.8,63,,80.64,percent of total Billed Charges,63% of total Billed Charges,136,85,,108.8,percent of total Billed Charges,85% of total Billed Charges,128,80,,102.4,percent of total Billed Charges,80% of total Billed Charges,99.2,62,,79.36,percent of total Billed Charges,62% of total Billed Charges,100.8,63,,80.64,percent of total Billed Charges,63% of total Billed Charges,99.2,62,,79.36,percent of total Billed Charges,62% of total Billed Charges,100.8,63,,80.64,percent of total billed charges,63% of total Billed Charges,99.2,62,,79.36,percent of total Billed Charges,62% of total Billed Charges,128,80,,102.4,percent of total Billed Charges,80% of Total Billed Charges,99.2,62,,79.36,percent of total Billed Charges,62% of total Billed Charges,99.2,62,,79.36,percent of total Billed Charges,62% of total Billed Charges,99.2,136,
Medical/surgical sterile supply,71791,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,71820,CDM,272,RC,,,Outpatient,,,55.65,38.955,,44.52,80,,35.616,percent of total Billed Charges,80% of Total Billed Charges,35.06,63,,28.048,percent of total Billed charges,63% of Total Billed Charges,34.5,62,,27.6,percent of total Billed Charges,62% of total BIlled charges,35.06,63,,28.048,percent of total Billed Charges,63% of total Billed Charges,47.3,85,,37.84,percent of total Billed Charges,85% of total Billed Charges,44.52,80,,35.616,percent of total Billed Charges,80% of total Billed Charges,34.5,62,,27.6,percent of total Billed Charges,62% of total Billed Charges,35.06,63,,28.048,percent of total Billed Charges,63% of total Billed Charges,34.5,62,,27.6,percent of total Billed Charges,62% of total Billed Charges,35.06,63,,28.048,percent of total billed charges,63% of total Billed Charges,34.5,62,,27.6,percent of total Billed Charges,62% of total Billed Charges,44.52,80,,35.616,percent of total Billed Charges,80% of Total Billed Charges,34.5,62,,27.6,percent of total Billed Charges,62% of total Billed Charges,34.5,62,,27.6,percent of total Billed Charges,62% of total Billed Charges,34.5,47.3,
Medical/surgical sterile supply,71833,CDM,272,RC,,,Outpatient,,,95,66.5,,76,80,,60.8,percent of total Billed Charges,80% of Total Billed Charges,59.85,63,,47.88,percent of total Billed charges,63% of Total Billed Charges,58.9,62,,47.12,percent of total Billed Charges,62% of total BIlled charges,59.85,63,,47.88,percent of total Billed Charges,63% of total Billed Charges,80.75,85,,64.6,percent of total Billed Charges,85% of total Billed Charges,76,80,,60.8,percent of total Billed Charges,80% of total Billed Charges,58.9,62,,47.12,percent of total Billed Charges,62% of total Billed Charges,59.85,63,,47.88,percent of total Billed Charges,63% of total Billed Charges,58.9,62,,47.12,percent of total Billed Charges,62% of total Billed Charges,59.85,63,,47.88,percent of total billed charges,63% of total Billed Charges,58.9,62,,47.12,percent of total Billed Charges,62% of total Billed Charges,76,80,,60.8,percent of total Billed Charges,80% of Total Billed Charges,58.9,62,,47.12,percent of total Billed Charges,62% of total Billed Charges,58.9,62,,47.12,percent of total Billed Charges,62% of total Billed Charges,58.9,80.75,
Medical/surgical sterile supply,72151,CDM,272,RC,,,Outpatient,,,19.81,13.867,,15.85,80,,12.68,percent of total Billed Charges,80% of Total Billed Charges,12.48,63,,9.984,percent of total Billed charges,63% of Total Billed Charges,12.28,62,,9.824,percent of total Billed Charges,62% of total BIlled charges,12.48,63,,9.984,percent of total Billed Charges,63% of total Billed Charges,16.84,85,,13.472,percent of total Billed Charges,85% of total Billed Charges,15.85,80,,12.68,percent of total Billed Charges,80% of total Billed Charges,12.28,62,,9.824,percent of total Billed Charges,62% of total Billed Charges,12.48,63,,9.984,percent of total Billed Charges,63% of total Billed Charges,12.28,62,,9.824,percent of total Billed Charges,62% of total Billed Charges,12.48,63,,9.984,percent of total billed charges,63% of total Billed Charges,12.28,62,,9.824,percent of total Billed Charges,62% of total Billed Charges,15.85,80,,12.68,percent of total Billed Charges,80% of Total Billed Charges,12.28,62,,9.824,percent of total Billed Charges,62% of total Billed Charges,12.28,62,,9.824,percent of total Billed Charges,62% of total Billed Charges,12.28,16.84,
Medical/surgical sterile supply,72353,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72043,CDM,272,RC,,,Outpatient,,,141,98.7,,112.8,80,,90.24,percent of total Billed Charges,80% of Total Billed Charges,88.83,63,,71.064,percent of total Billed charges,63% of Total Billed Charges,87.42,62,,69.936,percent of total Billed Charges,62% of total BIlled charges,88.83,63,,71.064,percent of total Billed Charges,63% of total Billed Charges,119.85,85,,95.88,percent of total Billed Charges,85% of total Billed Charges,112.8,80,,90.24,percent of total Billed Charges,80% of total Billed Charges,87.42,62,,69.936,percent of total Billed Charges,62% of total Billed Charges,88.83,63,,71.064,percent of total Billed Charges,63% of total Billed Charges,87.42,62,,69.936,percent of total Billed Charges,62% of total Billed Charges,88.83,63,,71.064,percent of total billed charges,63% of total Billed Charges,87.42,62,,69.936,percent of total Billed Charges,62% of total Billed Charges,112.8,80,,90.24,percent of total Billed Charges,80% of Total Billed Charges,87.42,62,,69.936,percent of total Billed Charges,62% of total Billed Charges,87.42,62,,69.936,percent of total Billed Charges,62% of total Billed Charges,87.42,119.85,
Medical/surgical sterile supply,72044,CDM,272,RC,,,Outpatient,,,93,65.1,,74.4,80,,59.52,percent of total Billed Charges,80% of Total Billed Charges,58.59,63,,46.872,percent of total Billed charges,63% of Total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total BIlled charges,58.59,63,,46.872,percent of total Billed Charges,63% of total Billed Charges,79.05,85,,63.24,percent of total Billed Charges,85% of total Billed Charges,74.4,80,,59.52,percent of total Billed Charges,80% of total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,58.59,63,,46.872,percent of total Billed Charges,63% of total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,58.59,63,,46.872,percent of total billed charges,63% of total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,74.4,80,,59.52,percent of total Billed Charges,80% of Total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,57.66,79.05,
Medical/surgical sterile supply,70808,CDM,272,RC,,,Outpatient,,,6,4.2,,4.8,80,,3.84,percent of total Billed Charges,80% of Total Billed Charges,3.78,63,,3.024,percent of total Billed charges,63% of Total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total BIlled charges,3.78,63,,3.024,percent of total Billed Charges,63% of total Billed Charges,5.1,85,,4.08,percent of total Billed Charges,85% of total Billed Charges,4.8,80,,3.84,percent of total Billed Charges,80% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.78,63,,3.024,percent of total Billed Charges,63% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.78,63,,3.024,percent of total billed charges,63% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,4.8,80,,3.84,percent of total Billed Charges,80% of Total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.72,62,,2.976,percent of total Billed Charges,62% of total Billed Charges,3.72,5.1,
Medical/surgical sterile supply,72354,CDM,272,RC,,,Outpatient,,,115.86,81.102,,92.69,80,,74.152,percent of total Billed Charges,80% of Total Billed Charges,72.99,63,,58.392,percent of total Billed charges,63% of Total Billed Charges,71.83,62,,57.464,percent of total Billed Charges,62% of total BIlled charges,72.99,63,,58.392,percent of total Billed Charges,63% of total Billed Charges,98.48,85,,78.784,percent of total Billed Charges,85% of total Billed Charges,92.69,80,,74.152,percent of total Billed Charges,80% of total Billed Charges,71.83,62,,57.464,percent of total Billed Charges,62% of total Billed Charges,72.99,63,,58.392,percent of total Billed Charges,63% of total Billed Charges,71.83,62,,57.464,percent of total Billed Charges,62% of total Billed Charges,72.99,63,,58.392,percent of total billed charges,63% of total Billed Charges,71.83,62,,57.464,percent of total Billed Charges,62% of total Billed Charges,92.69,80,,74.152,percent of total Billed Charges,80% of Total Billed Charges,71.83,62,,57.464,percent of total Billed Charges,62% of total Billed Charges,71.83,62,,57.464,percent of total Billed Charges,62% of total Billed Charges,71.83,98.48,
Medical/surgical sterile supply,72059,CDM,272,RC,,,Outpatient,,,8.09,5.663,,6.47,80,,5.176,percent of total Billed Charges,80% of Total Billed Charges,5.1,63,,4.08,percent of total Billed charges,63% of Total Billed Charges,5.02,62,,4.016,percent of total Billed Charges,62% of total BIlled charges,5.1,63,,4.08,percent of total Billed Charges,63% of total Billed Charges,6.88,85,,5.504,percent of total Billed Charges,85% of total Billed Charges,6.47,80,,5.176,percent of total Billed Charges,80% of total Billed Charges,5.02,62,,4.016,percent of total Billed Charges,62% of total Billed Charges,5.1,63,,4.08,percent of total Billed Charges,63% of total Billed Charges,5.02,62,,4.016,percent of total Billed Charges,62% of total Billed Charges,5.1,63,,4.08,percent of total billed charges,63% of total Billed Charges,5.02,62,,4.016,percent of total Billed Charges,62% of total Billed Charges,6.47,80,,5.176,percent of total Billed Charges,80% of Total Billed Charges,5.02,62,,4.016,percent of total Billed Charges,62% of total Billed Charges,5.02,62,,4.016,percent of total Billed Charges,62% of total Billed Charges,5.02,6.88,
Medical/surgical sterile supply,72159,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72072,CDM,272,RC,,,Outpatient,,,29.26,20.482,,23.41,80,,18.728,percent of total Billed Charges,80% of Total Billed Charges,18.43,63,,14.744,percent of total Billed charges,63% of Total Billed Charges,18.14,62,,14.512,percent of total Billed Charges,62% of total BIlled charges,18.43,63,,14.744,percent of total Billed Charges,63% of total Billed Charges,24.87,85,,19.896,percent of total Billed Charges,85% of total Billed Charges,23.41,80,,18.728,percent of total Billed Charges,80% of total Billed Charges,18.14,62,,14.512,percent of total Billed Charges,62% of total Billed Charges,18.43,63,,14.744,percent of total Billed Charges,63% of total Billed Charges,18.14,62,,14.512,percent of total Billed Charges,62% of total Billed Charges,18.43,63,,14.744,percent of total billed charges,63% of total Billed Charges,18.14,62,,14.512,percent of total Billed Charges,62% of total Billed Charges,23.41,80,,18.728,percent of total Billed Charges,80% of Total Billed Charges,18.14,62,,14.512,percent of total Billed Charges,62% of total Billed Charges,18.14,62,,14.512,percent of total Billed Charges,62% of total Billed Charges,18.14,24.87,
Medical/surgical sterile supply,72340,CDM,272,RC,,,Outpatient,,,77,53.9,,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,48.51,63,,38.808,percent of total Billed charges,63% of Total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total BIlled charges,48.51,63,,38.808,percent of total Billed Charges,63% of total Billed Charges,65.45,85,,52.36,percent of total Billed Charges,85% of total Billed Charges,61.6,80,,49.28,percent of total Billed Charges,80% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,48.51,63,,38.808,percent of total Billed Charges,63% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,48.51,63,,38.808,percent of total billed charges,63% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,47.74,65.45,
Medical/surgical sterile supply,71622,CDM,272,RC,,,Outpatient,,,236.25,165.375,,189,80,,151.2,percent of total Billed Charges,80% of Total Billed Charges,148.84,63,,119.072,percent of total Billed charges,63% of Total Billed Charges,146.48,62,,117.184,percent of total Billed Charges,62% of total BIlled charges,148.84,63,,119.072,percent of total Billed Charges,63% of total Billed Charges,200.81,85,,160.648,percent of total Billed Charges,85% of total Billed Charges,189,80,,151.2,percent of total Billed Charges,80% of total Billed Charges,146.48,62,,117.184,percent of total Billed Charges,62% of total Billed Charges,148.84,63,,119.072,percent of total Billed Charges,63% of total Billed Charges,146.48,62,,117.184,percent of total Billed Charges,62% of total Billed Charges,148.84,63,,119.072,percent of total billed charges,63% of total Billed Charges,146.48,62,,117.184,percent of total Billed Charges,62% of total Billed Charges,189,80,,151.2,percent of total Billed Charges,80% of Total Billed Charges,146.48,62,,117.184,percent of total Billed Charges,62% of total Billed Charges,146.48,62,,117.184,percent of total Billed Charges,62% of total Billed Charges,146.48,200.81,
Medical/surgical sterile supply,71586,CDM,272,RC,,,Outpatient,,,476.66,333.662,,381.33,80,,305.064,percent of total Billed Charges,80% of Total Billed Charges,300.3,63,,240.24,percent of total Billed charges,63% of Total Billed Charges,295.53,62,,236.424,percent of total Billed Charges,62% of total BIlled charges,300.3,63,,240.24,percent of total Billed Charges,63% of total Billed Charges,405.16,85,,324.128,percent of total Billed Charges,85% of total Billed Charges,381.33,80,,305.064,percent of total Billed Charges,80% of total Billed Charges,295.53,62,,236.424,percent of total Billed Charges,62% of total Billed Charges,300.3,63,,240.24,percent of total Billed Charges,63% of total Billed Charges,295.53,62,,236.424,percent of total Billed Charges,62% of total Billed Charges,300.3,63,,240.24,percent of total billed charges,63% of total Billed Charges,295.53,62,,236.424,percent of total Billed Charges,62% of total Billed Charges,381.33,80,,305.064,percent of total Billed Charges,80% of Total Billed Charges,295.53,62,,236.424,percent of total Billed Charges,62% of total Billed Charges,295.53,62,,236.424,percent of total Billed Charges,62% of total Billed Charges,295.53,405.16,
Medical/surgical sterile supply,71615,CDM,272,RC,,,Outpatient,,,108.16,75.712,,86.53,80,,69.224,percent of total Billed Charges,80% of Total Billed Charges,68.14,63,,54.512,percent of total Billed charges,63% of Total Billed Charges,67.06,62,,53.648,percent of total Billed Charges,62% of total BIlled charges,68.14,63,,54.512,percent of total Billed Charges,63% of total Billed Charges,91.94,85,,73.552,percent of total Billed Charges,85% of total Billed Charges,86.53,80,,69.224,percent of total Billed Charges,80% of total Billed Charges,67.06,62,,53.648,percent of total Billed Charges,62% of total Billed Charges,68.14,63,,54.512,percent of total Billed Charges,63% of total Billed Charges,67.06,62,,53.648,percent of total Billed Charges,62% of total Billed Charges,68.14,63,,54.512,percent of total billed charges,63% of total Billed Charges,67.06,62,,53.648,percent of total Billed Charges,62% of total Billed Charges,86.53,80,,69.224,percent of total Billed Charges,80% of Total Billed Charges,67.06,62,,53.648,percent of total Billed Charges,62% of total Billed Charges,67.06,62,,53.648,percent of total Billed Charges,62% of total Billed Charges,67.06,91.94,
Medical/surgical sterile supply,72168,CDM,272,RC,,,Outpatient,,,39.69,27.783,,31.75,80,,25.4,percent of total Billed Charges,80% of Total Billed Charges,25,63,,20,percent of total Billed charges,63% of Total Billed Charges,24.61,62,,19.688,percent of total Billed Charges,62% of total BIlled charges,25,63,,20,percent of total Billed Charges,63% of total Billed Charges,33.74,85,,26.992,percent of total Billed Charges,85% of total Billed Charges,31.75,80,,25.4,percent of total Billed Charges,80% of total Billed Charges,24.61,62,,19.688,percent of total Billed Charges,62% of total Billed Charges,25,63,,20,percent of total Billed Charges,63% of total Billed Charges,24.61,62,,19.688,percent of total Billed Charges,62% of total Billed Charges,25,63,,20,percent of total billed charges,63% of total Billed Charges,24.61,62,,19.688,percent of total Billed Charges,62% of total Billed Charges,31.75,80,,25.4,percent of total Billed Charges,80% of Total Billed Charges,24.61,62,,19.688,percent of total Billed Charges,62% of total Billed Charges,24.61,62,,19.688,percent of total Billed Charges,62% of total Billed Charges,24.61,33.74,
Medical/surgical sterile supply,72225,CDM,272,RC,,,Outpatient,,,61,42.7,,48.8,80,,39.04,percent of total Billed Charges,80% of Total Billed Charges,38.43,63,,30.744,percent of total Billed charges,63% of Total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total BIlled charges,38.43,63,,30.744,percent of total Billed Charges,63% of total Billed Charges,51.85,85,,41.48,percent of total Billed Charges,85% of total Billed Charges,48.8,80,,39.04,percent of total Billed Charges,80% of total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total Billed Charges,38.43,63,,30.744,percent of total Billed Charges,63% of total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total Billed Charges,38.43,63,,30.744,percent of total billed charges,63% of total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total Billed Charges,48.8,80,,39.04,percent of total Billed Charges,80% of Total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total Billed Charges,37.82,51.85,
Medical/surgical sterile supply,70761,CDM,272,RC,,,Outpatient,,,10.12,7.084,,8.1,80,,6.48,percent of total Billed Charges,80% of Total Billed Charges,6.38,63,,5.104,percent of total Billed charges,63% of Total Billed Charges,6.27,62,,5.016,percent of total Billed Charges,62% of total BIlled charges,6.38,63,,5.104,percent of total Billed Charges,63% of total Billed Charges,8.6,85,,6.88,percent of total Billed Charges,85% of total Billed Charges,8.1,80,,6.48,percent of total Billed Charges,80% of total Billed Charges,6.27,62,,5.016,percent of total Billed Charges,62% of total Billed Charges,6.38,63,,5.104,percent of total Billed Charges,63% of total Billed Charges,6.27,62,,5.016,percent of total Billed Charges,62% of total Billed Charges,6.38,63,,5.104,percent of total billed charges,63% of total Billed Charges,6.27,62,,5.016,percent of total Billed Charges,62% of total Billed Charges,8.1,80,,6.48,percent of total Billed Charges,80% of Total Billed Charges,6.27,62,,5.016,percent of total Billed Charges,62% of total Billed Charges,6.27,62,,5.016,percent of total Billed Charges,62% of total Billed Charges,6.27,8.6,
Medical/surgical sterile supply,72189,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72190,CDM,272,RC,,,Outpatient,,,15.62,10.934,,12.5,80,,10,percent of total Billed Charges,80% of Total Billed Charges,9.84,63,,7.872,percent of total Billed charges,63% of Total Billed Charges,9.68,62,,7.744,percent of total Billed Charges,62% of total BIlled charges,9.84,63,,7.872,percent of total Billed Charges,63% of total Billed Charges,13.28,85,,10.624,percent of total Billed Charges,85% of total Billed Charges,12.5,80,,10,percent of total Billed Charges,80% of total Billed Charges,9.68,62,,7.744,percent of total Billed Charges,62% of total Billed Charges,9.84,63,,7.872,percent of total Billed Charges,63% of total Billed Charges,9.68,62,,7.744,percent of total Billed Charges,62% of total Billed Charges,9.84,63,,7.872,percent of total billed charges,63% of total Billed Charges,9.68,62,,7.744,percent of total Billed Charges,62% of total Billed Charges,12.5,80,,10,percent of total Billed Charges,80% of Total Billed Charges,9.68,62,,7.744,percent of total Billed Charges,62% of total Billed Charges,9.68,62,,7.744,percent of total Billed Charges,62% of total Billed Charges,9.68,13.28,
Medical/surgical sterile supply,70907,CDM,272,RC,,,Outpatient,,,14,9.8,,11.2,80,,8.96,percent of total Billed Charges,80% of Total Billed Charges,8.82,63,,7.056,percent of total Billed charges,63% of Total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total BIlled charges,8.82,63,,7.056,percent of total Billed Charges,63% of total Billed Charges,11.9,85,,9.52,percent of total Billed Charges,85% of total Billed Charges,11.2,80,,8.96,percent of total Billed Charges,80% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.82,63,,7.056,percent of total Billed Charges,63% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.82,63,,7.056,percent of total billed charges,63% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,11.2,80,,8.96,percent of total Billed Charges,80% of Total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.68,11.9,
Medical/surgical sterile supply,72169,CDM,272,RC,,,Outpatient,,,72.73,50.911,,58.18,80,,46.544,percent of total Billed Charges,80% of Total Billed Charges,45.82,63,,36.656,percent of total Billed charges,63% of Total Billed Charges,45.09,62,,36.072,percent of total Billed Charges,62% of total BIlled charges,45.82,63,,36.656,percent of total Billed Charges,63% of total Billed Charges,61.82,85,,49.456,percent of total Billed Charges,85% of total Billed Charges,58.18,80,,46.544,percent of total Billed Charges,80% of total Billed Charges,45.09,62,,36.072,percent of total Billed Charges,62% of total Billed Charges,45.82,63,,36.656,percent of total Billed Charges,63% of total Billed Charges,45.09,62,,36.072,percent of total Billed Charges,62% of total Billed Charges,45.82,63,,36.656,percent of total billed charges,63% of total Billed Charges,45.09,62,,36.072,percent of total Billed Charges,62% of total Billed Charges,58.18,80,,46.544,percent of total Billed Charges,80% of Total Billed Charges,45.09,62,,36.072,percent of total Billed Charges,62% of total Billed Charges,45.09,62,,36.072,percent of total Billed Charges,62% of total Billed Charges,45.09,61.82,
Medical/surgical sterile supply,72000,CDM,272,RC,,,Outpatient,,,376,263.2,,300.8,80,,240.64,percent of total Billed Charges,80% of Total Billed Charges,236.88,63,,189.504,percent of total Billed charges,63% of Total Billed Charges,233.12,62,,186.496,percent of total Billed Charges,62% of total BIlled charges,236.88,63,,189.504,percent of total Billed Charges,63% of total Billed Charges,319.6,85,,255.68,percent of total Billed Charges,85% of total Billed Charges,300.8,80,,240.64,percent of total Billed Charges,80% of total Billed Charges,233.12,62,,186.496,percent of total Billed Charges,62% of total Billed Charges,236.88,63,,189.504,percent of total Billed Charges,63% of total Billed Charges,233.12,62,,186.496,percent of total Billed Charges,62% of total Billed Charges,236.88,63,,189.504,percent of total billed charges,63% of total Billed Charges,233.12,62,,186.496,percent of total Billed Charges,62% of total Billed Charges,300.8,80,,240.64,percent of total Billed Charges,80% of Total Billed Charges,233.12,62,,186.496,percent of total Billed Charges,62% of total Billed Charges,233.12,62,,186.496,percent of total Billed Charges,62% of total Billed Charges,233.12,319.6,
Medical/surgical sterile supply,71582,CDM,272,RC,,,Outpatient,,,279.65,195.755,,223.72,80,,178.976,percent of total Billed Charges,80% of Total Billed Charges,176.18,63,,140.944,percent of total Billed charges,63% of Total Billed Charges,173.38,62,,138.704,percent of total Billed Charges,62% of total BIlled charges,176.18,63,,140.944,percent of total Billed Charges,63% of total Billed Charges,237.7,85,,190.16,percent of total Billed Charges,85% of total Billed Charges,223.72,80,,178.976,percent of total Billed Charges,80% of total Billed Charges,173.38,62,,138.704,percent of total Billed Charges,62% of total Billed Charges,176.18,63,,140.944,percent of total Billed Charges,63% of total Billed Charges,173.38,62,,138.704,percent of total Billed Charges,62% of total Billed Charges,176.18,63,,140.944,percent of total billed charges,63% of total Billed Charges,173.38,62,,138.704,percent of total Billed Charges,62% of total Billed Charges,223.72,80,,178.976,percent of total Billed Charges,80% of Total Billed Charges,173.38,62,,138.704,percent of total Billed Charges,62% of total Billed Charges,173.38,62,,138.704,percent of total Billed Charges,62% of total Billed Charges,173.38,237.7,
Medical/surgical sterile supply,71758,CDM,272,RC,,,Outpatient,,,271.5,190.05,,217.2,80,,173.76,percent of total Billed Charges,80% of Total Billed Charges,171.05,63,,136.84,percent of total Billed charges,63% of Total Billed Charges,168.33,62,,134.664,percent of total Billed Charges,62% of total BIlled charges,171.05,63,,136.84,percent of total Billed Charges,63% of total Billed Charges,230.78,85,,184.624,percent of total Billed Charges,85% of total Billed Charges,217.2,80,,173.76,percent of total Billed Charges,80% of total Billed Charges,168.33,62,,134.664,percent of total Billed Charges,62% of total Billed Charges,171.05,63,,136.84,percent of total Billed Charges,63% of total Billed Charges,168.33,62,,134.664,percent of total Billed Charges,62% of total Billed Charges,171.05,63,,136.84,percent of total billed charges,63% of total Billed Charges,168.33,62,,134.664,percent of total Billed Charges,62% of total Billed Charges,217.2,80,,173.76,percent of total Billed Charges,80% of Total Billed Charges,168.33,62,,134.664,percent of total Billed Charges,62% of total Billed Charges,168.33,62,,134.664,percent of total Billed Charges,62% of total Billed Charges,168.33,230.78,
Medical/surgical sterile supply,70049,CDM,272,RC,,,Outpatient,,,8.12,5.684,,6.5,80,,5.2,percent of total Billed Charges,80% of Total Billed Charges,5.12,63,,4.096,percent of total Billed charges,63% of Total Billed Charges,5.03,62,,4.024,percent of total Billed Charges,62% of total BIlled charges,5.12,63,,4.096,percent of total Billed Charges,63% of total Billed Charges,6.9,85,,5.52,percent of total Billed Charges,85% of total Billed Charges,6.5,80,,5.2,percent of total Billed Charges,80% of total Billed Charges,5.03,62,,4.024,percent of total Billed Charges,62% of total Billed Charges,5.12,63,,4.096,percent of total Billed Charges,63% of total Billed Charges,5.03,62,,4.024,percent of total Billed Charges,62% of total Billed Charges,5.12,63,,4.096,percent of total billed charges,63% of total Billed Charges,5.03,62,,4.024,percent of total Billed Charges,62% of total Billed Charges,6.5,80,,5.2,percent of total Billed Charges,80% of Total Billed Charges,5.03,62,,4.024,percent of total Billed Charges,62% of total Billed Charges,5.03,62,,4.024,percent of total Billed Charges,62% of total Billed Charges,5.03,6.9,
Medical/surgical sterile supply,71400,CDM,272,RC,,,Outpatient,,,14.56,10.192,,11.65,80,,9.32,percent of total Billed Charges,80% of Total Billed Charges,9.17,63,,7.336,percent of total Billed charges,63% of Total Billed Charges,9.03,62,,7.224,percent of total Billed Charges,62% of total BIlled charges,9.17,63,,7.336,percent of total Billed Charges,63% of total Billed Charges,12.38,85,,9.904,percent of total Billed Charges,85% of total Billed Charges,11.65,80,,9.32,percent of total Billed Charges,80% of total Billed Charges,9.03,62,,7.224,percent of total Billed Charges,62% of total Billed Charges,9.17,63,,7.336,percent of total Billed Charges,63% of total Billed Charges,9.03,62,,7.224,percent of total Billed Charges,62% of total Billed Charges,9.17,63,,7.336,percent of total billed charges,63% of total Billed Charges,9.03,62,,7.224,percent of total Billed Charges,62% of total Billed Charges,11.65,80,,9.32,percent of total Billed Charges,80% of Total Billed Charges,9.03,62,,7.224,percent of total Billed Charges,62% of total Billed Charges,9.03,62,,7.224,percent of total Billed Charges,62% of total Billed Charges,9.03,12.38,
Medical/surgical sterile supply,72022,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70038,CDM,272,RC,,,Outpatient,,,20.97,14.679,,16.78,80,,13.424,percent of total Billed Charges,80% of Total Billed Charges,13.21,63,,10.568,percent of total Billed charges,63% of Total Billed Charges,13,62,,10.4,percent of total Billed Charges,62% of total BIlled charges,13.21,63,,10.568,percent of total Billed Charges,63% of total Billed Charges,17.82,85,,14.256,percent of total Billed Charges,85% of total Billed Charges,16.78,80,,13.424,percent of total Billed Charges,80% of total Billed Charges,13,62,,10.4,percent of total Billed Charges,62% of total Billed Charges,13.21,63,,10.568,percent of total Billed Charges,63% of total Billed Charges,13,62,,10.4,percent of total Billed Charges,62% of total Billed Charges,13.21,63,,10.568,percent of total billed charges,63% of total Billed Charges,13,62,,10.4,percent of total Billed Charges,62% of total Billed Charges,16.78,80,,13.424,percent of total Billed Charges,80% of Total Billed Charges,13,62,,10.4,percent of total Billed Charges,62% of total Billed Charges,13,62,,10.4,percent of total Billed Charges,62% of total Billed Charges,13,17.82,
Medical/surgical sterile supply,71783,CDM,272,RC,,,Outpatient,,,35,24.5,,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,22.05,63,,17.64,percent of total Billed charges,63% of Total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total BIlled charges,22.05,63,,17.64,percent of total Billed Charges,63% of total Billed Charges,29.75,85,,23.8,percent of total Billed Charges,85% of total Billed Charges,28,80,,22.4,percent of total Billed Charges,80% of total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total Billed Charges,22.05,63,,17.64,percent of total Billed Charges,63% of total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total Billed Charges,22.05,63,,17.64,percent of total billed charges,63% of total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total Billed Charges,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total Billed Charges,21.7,29.75,
Medical/surgical sterile supply,70853,CDM,272,RC,,,Outpatient,,,20.83,14.581,,16.66,80,,13.328,percent of total Billed Charges,80% of Total Billed Charges,13.12,63,,10.496,percent of total Billed charges,63% of Total Billed Charges,12.91,62,,10.328,percent of total Billed Charges,62% of total BIlled charges,13.12,63,,10.496,percent of total Billed Charges,63% of total Billed Charges,17.71,85,,14.168,percent of total Billed Charges,85% of total Billed Charges,16.66,80,,13.328,percent of total Billed Charges,80% of total Billed Charges,12.91,62,,10.328,percent of total Billed Charges,62% of total Billed Charges,13.12,63,,10.496,percent of total Billed Charges,63% of total Billed Charges,12.91,62,,10.328,percent of total Billed Charges,62% of total Billed Charges,13.12,63,,10.496,percent of total billed charges,63% of total Billed Charges,12.91,62,,10.328,percent of total Billed Charges,62% of total Billed Charges,16.66,80,,13.328,percent of total Billed Charges,80% of Total Billed Charges,12.91,62,,10.328,percent of total Billed Charges,62% of total Billed Charges,12.91,62,,10.328,percent of total Billed Charges,62% of total Billed Charges,12.91,17.71,
Medical/surgical sterile supply,72214,CDM,272,RC,,,Outpatient,,,7.5,5.25,,6,80,,4.8,percent of total Billed Charges,80% of Total Billed Charges,4.73,63,,3.784,percent of total Billed charges,63% of Total Billed Charges,4.65,62,,3.72,percent of total Billed Charges,62% of total BIlled charges,4.73,63,,3.784,percent of total Billed Charges,63% of total Billed Charges,6.38,85,,5.104,percent of total Billed Charges,85% of total Billed Charges,6,80,,4.8,percent of total Billed Charges,80% of total Billed Charges,4.65,62,,3.72,percent of total Billed Charges,62% of total Billed Charges,4.73,63,,3.784,percent of total Billed Charges,63% of total Billed Charges,4.65,62,,3.72,percent of total Billed Charges,62% of total Billed Charges,4.73,63,,3.784,percent of total billed charges,63% of total Billed Charges,4.65,62,,3.72,percent of total Billed Charges,62% of total Billed Charges,6,80,,4.8,percent of total Billed Charges,80% of Total Billed Charges,4.65,62,,3.72,percent of total Billed Charges,62% of total Billed Charges,4.65,62,,3.72,percent of total Billed Charges,62% of total Billed Charges,4.65,6.38,
Medical/surgical sterile supply,72215,CDM,272,RC,,,Outpatient,,,12.5,8.75,,10,80,,8,percent of total Billed Charges,80% of Total Billed Charges,7.88,63,,6.304,percent of total Billed charges,63% of Total Billed Charges,7.75,62,,6.2,percent of total Billed Charges,62% of total BIlled charges,7.88,63,,6.304,percent of total Billed Charges,63% of total Billed Charges,10.63,85,,8.504,percent of total Billed Charges,85% of total Billed Charges,10,80,,8,percent of total Billed Charges,80% of total Billed Charges,7.75,62,,6.2,percent of total Billed Charges,62% of total Billed Charges,7.88,63,,6.304,percent of total Billed Charges,63% of total Billed Charges,7.75,62,,6.2,percent of total Billed Charges,62% of total Billed Charges,7.88,63,,6.304,percent of total billed charges,63% of total Billed Charges,7.75,62,,6.2,percent of total Billed Charges,62% of total Billed Charges,10,80,,8,percent of total Billed Charges,80% of Total Billed Charges,7.75,62,,6.2,percent of total Billed Charges,62% of total Billed Charges,7.75,62,,6.2,percent of total Billed Charges,62% of total Billed Charges,7.75,10.63,
Medical/surgical sterile supply,72217,CDM,272,RC,,,Outpatient,,,8,5.6,,6.4,80,,5.12,percent of total Billed Charges,80% of Total Billed Charges,5.04,63,,4.032,percent of total Billed charges,63% of Total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total BIlled charges,5.04,63,,4.032,percent of total Billed Charges,63% of total Billed Charges,6.8,85,,5.44,percent of total Billed Charges,85% of total Billed Charges,6.4,80,,5.12,percent of total Billed Charges,80% of total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,5.04,63,,4.032,percent of total Billed Charges,63% of total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,5.04,63,,4.032,percent of total billed charges,63% of total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,6.4,80,,5.12,percent of total Billed Charges,80% of Total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,4.96,62,,3.968,percent of total Billed Charges,62% of total Billed Charges,4.96,6.8,
Medical/surgical sterile supply,72218,CDM,272,RC,,,Outpatient,,,8.5,5.95,,6.8,80,,5.44,percent of total Billed Charges,80% of Total Billed Charges,5.36,63,,4.288,percent of total Billed charges,63% of Total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total BIlled charges,5.36,63,,4.288,percent of total Billed Charges,63% of total Billed Charges,7.23,85,,5.784,percent of total Billed Charges,85% of total Billed Charges,6.8,80,,5.44,percent of total Billed Charges,80% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.36,63,,4.288,percent of total Billed Charges,63% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.36,63,,4.288,percent of total billed charges,63% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,6.8,80,,5.44,percent of total Billed Charges,80% of Total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.27,7.23,
Medical/surgical sterile supply,170047,CDM,272,RC,,,Outpatient,,,31,21.7,,24.8,80,,19.84,percent of total Billed Charges,80% of Total Billed Charges,19.53,63,,15.624,percent of total Billed charges,63% of Total Billed Charges,19.22,62,,15.376,percent of total Billed Charges,62% of total BIlled charges,19.53,63,,15.624,percent of total Billed Charges,63% of total Billed Charges,26.35,85,,21.08,percent of total Billed Charges,85% of total Billed Charges,24.8,80,,19.84,percent of total Billed Charges,80% of total Billed Charges,19.22,62,,15.376,percent of total Billed Charges,62% of total Billed Charges,19.53,63,,15.624,percent of total Billed Charges,63% of total Billed Charges,19.22,62,,15.376,percent of total Billed Charges,62% of total Billed Charges,19.53,63,,15.624,percent of total billed charges,63% of total Billed Charges,19.22,62,,15.376,percent of total Billed Charges,62% of total Billed Charges,24.8,80,,19.84,percent of total Billed Charges,80% of Total Billed Charges,19.22,62,,15.376,percent of total Billed Charges,62% of total Billed Charges,19.22,62,,15.376,percent of total Billed Charges,62% of total Billed Charges,19.22,26.35,
Medical/surgical sterile supply,71675,CDM,272,RC,,,Outpatient,,,12.99,9.093,,10.39,80,,8.312,percent of total Billed Charges,80% of Total Billed Charges,8.18,63,,6.544,percent of total Billed charges,63% of Total Billed Charges,8.05,62,,6.44,percent of total Billed Charges,62% of total BIlled charges,8.18,63,,6.544,percent of total Billed Charges,63% of total Billed Charges,11.04,85,,8.832,percent of total Billed Charges,85% of total Billed Charges,10.39,80,,8.312,percent of total Billed Charges,80% of total Billed Charges,8.05,62,,6.44,percent of total Billed Charges,62% of total Billed Charges,8.18,63,,6.544,percent of total Billed Charges,63% of total Billed Charges,8.05,62,,6.44,percent of total Billed Charges,62% of total Billed Charges,8.18,63,,6.544,percent of total billed charges,63% of total Billed Charges,8.05,62,,6.44,percent of total Billed Charges,62% of total Billed Charges,10.39,80,,8.312,percent of total Billed Charges,80% of Total Billed Charges,8.05,62,,6.44,percent of total Billed Charges,62% of total Billed Charges,8.05,62,,6.44,percent of total Billed Charges,62% of total Billed Charges,8.05,11.04,
Medical/surgical sterile supply,71539,CDM,272,RC,,,Outpatient,,,21.14,14.798,,16.91,80,,13.528,percent of total Billed Charges,80% of Total Billed Charges,13.32,63,,10.656,percent of total Billed charges,63% of Total Billed Charges,13.11,62,,10.488,percent of total Billed Charges,62% of total BIlled charges,13.32,63,,10.656,percent of total Billed Charges,63% of total Billed Charges,17.97,85,,14.376,percent of total Billed Charges,85% of total Billed Charges,16.91,80,,13.528,percent of total Billed Charges,80% of total Billed Charges,13.11,62,,10.488,percent of total Billed Charges,62% of total Billed Charges,13.32,63,,10.656,percent of total Billed Charges,63% of total Billed Charges,13.11,62,,10.488,percent of total Billed Charges,62% of total Billed Charges,13.32,63,,10.656,percent of total billed charges,63% of total Billed Charges,13.11,62,,10.488,percent of total Billed Charges,62% of total Billed Charges,16.91,80,,13.528,percent of total Billed Charges,80% of Total Billed Charges,13.11,62,,10.488,percent of total Billed Charges,62% of total Billed Charges,13.11,62,,10.488,percent of total Billed Charges,62% of total Billed Charges,13.11,17.97,
Medical/surgical sterile supply,71538,CDM,272,RC,,,Outpatient,,,17.43,12.201,,13.94,80,,11.152,percent of total Billed Charges,80% of Total Billed Charges,10.98,63,,8.784,percent of total Billed charges,63% of Total Billed Charges,10.81,62,,8.648,percent of total Billed Charges,62% of total BIlled charges,10.98,63,,8.784,percent of total Billed Charges,63% of total Billed Charges,14.82,85,,11.856,percent of total Billed Charges,85% of total Billed Charges,13.94,80,,11.152,percent of total Billed Charges,80% of total Billed Charges,10.81,62,,8.648,percent of total Billed Charges,62% of total Billed Charges,10.98,63,,8.784,percent of total Billed Charges,63% of total Billed Charges,10.81,62,,8.648,percent of total Billed Charges,62% of total Billed Charges,10.98,63,,8.784,percent of total billed charges,63% of total Billed Charges,10.81,62,,8.648,percent of total Billed Charges,62% of total Billed Charges,13.94,80,,11.152,percent of total Billed Charges,80% of Total Billed Charges,10.81,62,,8.648,percent of total Billed Charges,62% of total Billed Charges,10.81,62,,8.648,percent of total Billed Charges,62% of total Billed Charges,10.81,14.82,
Medical/surgical sterile supply,71596,CDM,272,RC,,,Outpatient,,,14.14,9.898,,11.31,80,,9.048,percent of total Billed Charges,80% of Total Billed Charges,8.91,63,,7.128,percent of total Billed charges,63% of Total Billed Charges,8.77,62,,7.016,percent of total Billed Charges,62% of total BIlled charges,8.91,63,,7.128,percent of total Billed Charges,63% of total Billed Charges,12.02,85,,9.616,percent of total Billed Charges,85% of total Billed Charges,11.31,80,,9.048,percent of total Billed Charges,80% of total Billed Charges,8.77,62,,7.016,percent of total Billed Charges,62% of total Billed Charges,8.91,63,,7.128,percent of total Billed Charges,63% of total Billed Charges,8.77,62,,7.016,percent of total Billed Charges,62% of total Billed Charges,8.91,63,,7.128,percent of total billed charges,63% of total Billed Charges,8.77,62,,7.016,percent of total Billed Charges,62% of total Billed Charges,11.31,80,,9.048,percent of total Billed Charges,80% of Total Billed Charges,8.77,62,,7.016,percent of total Billed Charges,62% of total Billed Charges,8.77,62,,7.016,percent of total Billed Charges,62% of total Billed Charges,8.77,12.02,
Medical/surgical sterile supply,72076,CDM,272,RC,,,Outpatient,,,21.14,14.798,,16.91,80,,13.528,percent of total Billed Charges,80% of Total Billed Charges,13.32,63,,10.656,percent of total Billed charges,63% of Total Billed Charges,13.11,62,,10.488,percent of total Billed Charges,62% of total BIlled charges,13.32,63,,10.656,percent of total Billed Charges,63% of total Billed Charges,17.97,85,,14.376,percent of total Billed Charges,85% of total Billed Charges,16.91,80,,13.528,percent of total Billed Charges,80% of total Billed Charges,13.11,62,,10.488,percent of total Billed Charges,62% of total Billed Charges,13.32,63,,10.656,percent of total Billed Charges,63% of total Billed Charges,13.11,62,,10.488,percent of total Billed Charges,62% of total Billed Charges,13.32,63,,10.656,percent of total billed charges,63% of total Billed Charges,13.11,62,,10.488,percent of total Billed Charges,62% of total Billed Charges,16.91,80,,13.528,percent of total Billed Charges,80% of Total Billed Charges,13.11,62,,10.488,percent of total Billed Charges,62% of total Billed Charges,13.11,62,,10.488,percent of total Billed Charges,62% of total Billed Charges,13.11,17.97,
Medical/surgical sterile supply,71537,CDM,272,RC,,,Outpatient,,,16.5,11.55,,13.2,80,,10.56,percent of total Billed Charges,80% of Total Billed Charges,10.4,63,,8.32,percent of total Billed charges,63% of Total Billed Charges,10.23,62,,8.184,percent of total Billed Charges,62% of total BIlled charges,10.4,63,,8.32,percent of total Billed Charges,63% of total Billed Charges,14.03,85,,11.224,percent of total Billed Charges,85% of total Billed Charges,13.2,80,,10.56,percent of total Billed Charges,80% of total Billed Charges,10.23,62,,8.184,percent of total Billed Charges,62% of total Billed Charges,10.4,63,,8.32,percent of total Billed Charges,63% of total Billed Charges,10.23,62,,8.184,percent of total Billed Charges,62% of total Billed Charges,10.4,63,,8.32,percent of total billed charges,63% of total Billed Charges,10.23,62,,8.184,percent of total Billed Charges,62% of total Billed Charges,13.2,80,,10.56,percent of total Billed Charges,80% of Total Billed Charges,10.23,62,,8.184,percent of total Billed Charges,62% of total Billed Charges,10.23,62,,8.184,percent of total Billed Charges,62% of total Billed Charges,10.23,14.03,
Medical/surgical sterile supply,72166,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72305,CDM,272,RC,,,Outpatient,,,56,39.2,,44.8,80,,35.84,percent of total Billed Charges,80% of Total Billed Charges,35.28,63,,28.224,percent of total Billed charges,63% of Total Billed Charges,34.72,62,,27.776,percent of total Billed Charges,62% of total BIlled charges,35.28,63,,28.224,percent of total Billed Charges,63% of total Billed Charges,47.6,85,,38.08,percent of total Billed Charges,85% of total Billed Charges,44.8,80,,35.84,percent of total Billed Charges,80% of total Billed Charges,34.72,62,,27.776,percent of total Billed Charges,62% of total Billed Charges,35.28,63,,28.224,percent of total Billed Charges,63% of total Billed Charges,34.72,62,,27.776,percent of total Billed Charges,62% of total Billed Charges,35.28,63,,28.224,percent of total billed charges,63% of total Billed Charges,34.72,62,,27.776,percent of total Billed Charges,62% of total Billed Charges,44.8,80,,35.84,percent of total Billed Charges,80% of Total Billed Charges,34.72,62,,27.776,percent of total Billed Charges,62% of total Billed Charges,34.72,62,,27.776,percent of total Billed Charges,62% of total Billed Charges,34.72,47.6,
Medical/surgical sterile supply,71104,CDM,272,RC,,,Outpatient,,,21,14.7,,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.23,63,,10.584,percent of total Billed charges,63% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total BIlled charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,17.85,85,,14.28,percent of total Billed Charges,85% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total billed charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,17.85,
Medical/surgical sterile supply,72150,CDM,272,RC,,,Outpatient,,,21.5,15.05,,17.2,80,,13.76,percent of total Billed Charges,80% of Total Billed Charges,13.55,63,,10.84,percent of total Billed charges,63% of Total Billed Charges,13.33,62,,10.664,percent of total Billed Charges,62% of total BIlled charges,13.55,63,,10.84,percent of total Billed Charges,63% of total Billed Charges,18.28,85,,14.624,percent of total Billed Charges,85% of total Billed Charges,17.2,80,,13.76,percent of total Billed Charges,80% of total Billed Charges,13.33,62,,10.664,percent of total Billed Charges,62% of total Billed Charges,13.55,63,,10.84,percent of total Billed Charges,63% of total Billed Charges,13.33,62,,10.664,percent of total Billed Charges,62% of total Billed Charges,13.55,63,,10.84,percent of total billed charges,63% of total Billed Charges,13.33,62,,10.664,percent of total Billed Charges,62% of total Billed Charges,17.2,80,,13.76,percent of total Billed Charges,80% of Total Billed Charges,13.33,62,,10.664,percent of total Billed Charges,62% of total Billed Charges,13.33,62,,10.664,percent of total Billed Charges,62% of total Billed Charges,13.33,18.28,
Medical/surgical sterile supply,50066,CDM,272,RC,,,Outpatient,,,82.88,58.016,,66.3,80,,53.04,percent of total Billed Charges,80% of Total Billed Charges,52.21,63,,41.768,percent of total Billed charges,63% of Total Billed Charges,51.39,62,,41.112,percent of total Billed Charges,62% of total BIlled charges,52.21,63,,41.768,percent of total Billed Charges,63% of total Billed Charges,70.45,85,,56.36,percent of total Billed Charges,85% of total Billed Charges,66.3,80,,53.04,percent of total Billed Charges,80% of total Billed Charges,51.39,62,,41.112,percent of total Billed Charges,62% of total Billed Charges,52.21,63,,41.768,percent of total Billed Charges,63% of total Billed Charges,51.39,62,,41.112,percent of total Billed Charges,62% of total Billed Charges,52.21,63,,41.768,percent of total billed charges,63% of total Billed Charges,51.39,62,,41.112,percent of total Billed Charges,62% of total Billed Charges,66.3,80,,53.04,percent of total Billed Charges,80% of Total Billed Charges,51.39,62,,41.112,percent of total Billed Charges,62% of total Billed Charges,51.39,62,,41.112,percent of total Billed Charges,62% of total Billed Charges,51.39,70.45,
Medical/surgical sterile supply,72117,CDM,272,RC,,,Outpatient,,,15.04,10.528,,12.03,80,,9.624,percent of total Billed Charges,80% of Total Billed Charges,9.48,63,,7.584,percent of total Billed charges,63% of Total Billed Charges,9.32,62,,7.456,percent of total Billed Charges,62% of total BIlled charges,9.48,63,,7.584,percent of total Billed Charges,63% of total Billed Charges,12.78,85,,10.224,percent of total Billed Charges,85% of total Billed Charges,12.03,80,,9.624,percent of total Billed Charges,80% of total Billed Charges,9.32,62,,7.456,percent of total Billed Charges,62% of total Billed Charges,9.48,63,,7.584,percent of total Billed Charges,63% of total Billed Charges,9.32,62,,7.456,percent of total Billed Charges,62% of total Billed Charges,9.48,63,,7.584,percent of total billed charges,63% of total Billed Charges,9.32,62,,7.456,percent of total Billed Charges,62% of total Billed Charges,12.03,80,,9.624,percent of total Billed Charges,80% of Total Billed Charges,9.32,62,,7.456,percent of total Billed Charges,62% of total Billed Charges,9.32,62,,7.456,percent of total Billed Charges,62% of total Billed Charges,9.32,12.78,
Medical/surgical sterile supply,71663,CDM,272,RC,,,Outpatient,,,9.76,6.832,,7.81,80,,6.248,percent of total Billed Charges,80% of Total Billed Charges,6.15,63,,4.92,percent of total Billed charges,63% of Total Billed Charges,6.05,62,,4.84,percent of total Billed Charges,62% of total BIlled charges,6.15,63,,4.92,percent of total Billed Charges,63% of total Billed Charges,8.3,85,,6.64,percent of total Billed Charges,85% of total Billed Charges,7.81,80,,6.248,percent of total Billed Charges,80% of total Billed Charges,6.05,62,,4.84,percent of total Billed Charges,62% of total Billed Charges,6.15,63,,4.92,percent of total Billed Charges,63% of total Billed Charges,6.05,62,,4.84,percent of total Billed Charges,62% of total Billed Charges,6.15,63,,4.92,percent of total billed charges,63% of total Billed Charges,6.05,62,,4.84,percent of total Billed Charges,62% of total Billed Charges,7.81,80,,6.248,percent of total Billed Charges,80% of Total Billed Charges,6.05,62,,4.84,percent of total Billed Charges,62% of total Billed Charges,6.05,62,,4.84,percent of total Billed Charges,62% of total Billed Charges,6.05,8.3,
Medical/surgical sterile supply,72332,CDM,272,RC,,,Outpatient,,,29.01,20.307,,23.21,80,,18.568,percent of total Billed Charges,80% of Total Billed Charges,18.28,63,,14.624,percent of total Billed charges,63% of Total Billed Charges,17.99,62,,14.392,percent of total Billed Charges,62% of total BIlled charges,18.28,63,,14.624,percent of total Billed Charges,63% of total Billed Charges,24.66,85,,19.728,percent of total Billed Charges,85% of total Billed Charges,23.21,80,,18.568,percent of total Billed Charges,80% of total Billed Charges,17.99,62,,14.392,percent of total Billed Charges,62% of total Billed Charges,18.28,63,,14.624,percent of total Billed Charges,63% of total Billed Charges,17.99,62,,14.392,percent of total Billed Charges,62% of total Billed Charges,18.28,63,,14.624,percent of total billed charges,63% of total Billed Charges,17.99,62,,14.392,percent of total Billed Charges,62% of total Billed Charges,23.21,80,,18.568,percent of total Billed Charges,80% of Total Billed Charges,17.99,62,,14.392,percent of total Billed Charges,62% of total Billed Charges,17.99,62,,14.392,percent of total Billed Charges,62% of total Billed Charges,17.99,24.66,
Medical/surgical sterile supply,71804,CDM,272,RC,,,Outpatient,,,5.74,4.018,,4.59,80,,3.672,percent of total Billed Charges,80% of Total Billed Charges,3.62,63,,2.896,percent of total Billed charges,63% of Total Billed Charges,3.56,62,,2.848,percent of total Billed Charges,62% of total BIlled charges,3.62,63,,2.896,percent of total Billed Charges,63% of total Billed Charges,4.88,85,,3.904,percent of total Billed Charges,85% of total Billed Charges,4.59,80,,3.672,percent of total Billed Charges,80% of total Billed Charges,3.56,62,,2.848,percent of total Billed Charges,62% of total Billed Charges,3.62,63,,2.896,percent of total Billed Charges,63% of total Billed Charges,3.56,62,,2.848,percent of total Billed Charges,62% of total Billed Charges,3.62,63,,2.896,percent of total billed charges,63% of total Billed Charges,3.56,62,,2.848,percent of total Billed Charges,62% of total Billed Charges,4.59,80,,3.672,percent of total Billed Charges,80% of Total Billed Charges,3.56,62,,2.848,percent of total Billed Charges,62% of total Billed Charges,3.56,62,,2.848,percent of total Billed Charges,62% of total Billed Charges,3.56,4.88,
Medical/surgical sterile supply,71860,CDM,272,RC,,,Outpatient,,,45.5,31.85,,36.4,80,,29.12,percent of total Billed Charges,80% of Total Billed Charges,28.67,63,,22.936,percent of total Billed charges,63% of Total Billed Charges,28.21,62,,22.568,percent of total Billed Charges,62% of total BIlled charges,28.67,63,,22.936,percent of total Billed Charges,63% of total Billed Charges,38.68,85,,30.944,percent of total Billed Charges,85% of total Billed Charges,36.4,80,,29.12,percent of total Billed Charges,80% of total Billed Charges,28.21,62,,22.568,percent of total Billed Charges,62% of total Billed Charges,28.67,63,,22.936,percent of total Billed Charges,63% of total Billed Charges,28.21,62,,22.568,percent of total Billed Charges,62% of total Billed Charges,28.67,63,,22.936,percent of total billed charges,63% of total Billed Charges,28.21,62,,22.568,percent of total Billed Charges,62% of total Billed Charges,36.4,80,,29.12,percent of total Billed Charges,80% of Total Billed Charges,28.21,62,,22.568,percent of total Billed Charges,62% of total Billed Charges,28.21,62,,22.568,percent of total Billed Charges,62% of total Billed Charges,28.21,38.68,
Medical/surgical sterile supply,71859,CDM,272,RC,,,Outpatient,,,16.5,11.55,,13.2,80,,10.56,percent of total Billed Charges,80% of Total Billed Charges,10.4,63,,8.32,percent of total Billed charges,63% of Total Billed Charges,10.23,62,,8.184,percent of total Billed Charges,62% of total BIlled charges,10.4,63,,8.32,percent of total Billed Charges,63% of total Billed Charges,14.03,85,,11.224,percent of total Billed Charges,85% of total Billed Charges,13.2,80,,10.56,percent of total Billed Charges,80% of total Billed Charges,10.23,62,,8.184,percent of total Billed Charges,62% of total Billed Charges,10.4,63,,8.32,percent of total Billed Charges,63% of total Billed Charges,10.23,62,,8.184,percent of total Billed Charges,62% of total Billed Charges,10.4,63,,8.32,percent of total billed charges,63% of total Billed Charges,10.23,62,,8.184,percent of total Billed Charges,62% of total Billed Charges,13.2,80,,10.56,percent of total Billed Charges,80% of Total Billed Charges,10.23,62,,8.184,percent of total Billed Charges,62% of total Billed Charges,10.23,62,,8.184,percent of total Billed Charges,62% of total Billed Charges,10.23,14.03,
Medical/surgical sterile supply,70834,CDM,272,RC,,,Outpatient,,,5.5,3.85,,4.4,80,,3.52,percent of total Billed Charges,80% of Total Billed Charges,3.47,63,,2.776,percent of total Billed charges,63% of Total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total BIlled charges,3.47,63,,2.776,percent of total Billed Charges,63% of total Billed Charges,4.68,85,,3.744,percent of total Billed Charges,85% of total Billed Charges,4.4,80,,3.52,percent of total Billed Charges,80% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.47,63,,2.776,percent of total Billed Charges,63% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.47,63,,2.776,percent of total billed charges,63% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,4.4,80,,3.52,percent of total Billed Charges,80% of Total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.41,4.68,
Medical/surgical sterile supply,70838,CDM,272,RC,,,Outpatient,,,5.5,3.85,,4.4,80,,3.52,percent of total Billed Charges,80% of Total Billed Charges,3.47,63,,2.776,percent of total Billed charges,63% of Total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total BIlled charges,3.47,63,,2.776,percent of total Billed Charges,63% of total Billed Charges,4.68,85,,3.744,percent of total Billed Charges,85% of total Billed Charges,4.4,80,,3.52,percent of total Billed Charges,80% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.47,63,,2.776,percent of total Billed Charges,63% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.47,63,,2.776,percent of total billed charges,63% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,4.4,80,,3.52,percent of total Billed Charges,80% of Total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.41,4.68,
Medical/surgical sterile supply,70503,CDM,272,RC,,,Outpatient,,,5.39,3.773,,4.31,80,,3.448,percent of total Billed Charges,80% of Total Billed Charges,3.4,63,,2.72,percent of total Billed charges,63% of Total Billed Charges,3.34,62,,2.672,percent of total Billed Charges,62% of total BIlled charges,3.4,63,,2.72,percent of total Billed Charges,63% of total Billed Charges,4.58,85,,3.664,percent of total Billed Charges,85% of total Billed Charges,4.31,80,,3.448,percent of total Billed Charges,80% of total Billed Charges,3.34,62,,2.672,percent of total Billed Charges,62% of total Billed Charges,3.4,63,,2.72,percent of total Billed Charges,63% of total Billed Charges,3.34,62,,2.672,percent of total Billed Charges,62% of total Billed Charges,3.4,63,,2.72,percent of total billed charges,63% of total Billed Charges,3.34,62,,2.672,percent of total Billed Charges,62% of total Billed Charges,4.31,80,,3.448,percent of total Billed Charges,80% of Total Billed Charges,3.34,62,,2.672,percent of total Billed Charges,62% of total Billed Charges,3.34,62,,2.672,percent of total Billed Charges,62% of total Billed Charges,3.34,4.58,
Medical/surgical sterile supply,70835,CDM,272,RC,,,Outpatient,,,5.5,3.85,,4.4,80,,3.52,percent of total Billed Charges,80% of Total Billed Charges,3.47,63,,2.776,percent of total Billed charges,63% of Total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total BIlled charges,3.47,63,,2.776,percent of total Billed Charges,63% of total Billed Charges,4.68,85,,3.744,percent of total Billed Charges,85% of total Billed Charges,4.4,80,,3.52,percent of total Billed Charges,80% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.47,63,,2.776,percent of total Billed Charges,63% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.47,63,,2.776,percent of total billed charges,63% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,4.4,80,,3.52,percent of total Billed Charges,80% of Total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.41,4.68,
Medical/surgical sterile supply,70837,CDM,272,RC,,,Outpatient,,,5.5,3.85,,4.4,80,,3.52,percent of total Billed Charges,80% of Total Billed Charges,3.47,63,,2.776,percent of total Billed charges,63% of Total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total BIlled charges,3.47,63,,2.776,percent of total Billed Charges,63% of total Billed Charges,4.68,85,,3.744,percent of total Billed Charges,85% of total Billed Charges,4.4,80,,3.52,percent of total Billed Charges,80% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.47,63,,2.776,percent of total Billed Charges,63% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.47,63,,2.776,percent of total billed charges,63% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,4.4,80,,3.52,percent of total Billed Charges,80% of Total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.41,4.68,
Medical/surgical sterile supply,72037,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72179,CDM,272,RC,,,Outpatient,,,15.93,11.151,,12.74,80,,10.192,percent of total Billed Charges,80% of Total Billed Charges,10.04,63,,8.032,percent of total Billed charges,63% of Total Billed Charges,9.88,62,,7.904,percent of total Billed Charges,62% of total BIlled charges,10.04,63,,8.032,percent of total Billed Charges,63% of total Billed Charges,13.54,85,,10.832,percent of total Billed Charges,85% of total Billed Charges,12.74,80,,10.192,percent of total Billed Charges,80% of total Billed Charges,9.88,62,,7.904,percent of total Billed Charges,62% of total Billed Charges,10.04,63,,8.032,percent of total Billed Charges,63% of total Billed Charges,9.88,62,,7.904,percent of total Billed Charges,62% of total Billed Charges,10.04,63,,8.032,percent of total billed charges,63% of total Billed Charges,9.88,62,,7.904,percent of total Billed Charges,62% of total Billed Charges,12.74,80,,10.192,percent of total Billed Charges,80% of Total Billed Charges,9.88,62,,7.904,percent of total Billed Charges,62% of total Billed Charges,9.88,62,,7.904,percent of total Billed Charges,62% of total Billed Charges,9.88,13.54,
Medical/surgical sterile supply,72115,CDM,272,RC,,,Outpatient,,,8.5,5.95,,6.8,80,,5.44,percent of total Billed Charges,80% of Total Billed Charges,5.36,63,,4.288,percent of total Billed charges,63% of Total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total BIlled charges,5.36,63,,4.288,percent of total Billed Charges,63% of total Billed Charges,7.23,85,,5.784,percent of total Billed Charges,85% of total Billed Charges,6.8,80,,5.44,percent of total Billed Charges,80% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.36,63,,4.288,percent of total Billed Charges,63% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.36,63,,4.288,percent of total billed charges,63% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,6.8,80,,5.44,percent of total Billed Charges,80% of Total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.27,7.23,
Medical/surgical sterile supply,72118,CDM,272,RC,,,Outpatient,,,15.5,10.85,,12.4,80,,9.92,percent of total Billed Charges,80% of Total Billed Charges,9.77,63,,7.816,percent of total Billed charges,63% of Total Billed Charges,9.61,62,,7.688,percent of total Billed Charges,62% of total BIlled charges,9.77,63,,7.816,percent of total Billed Charges,63% of total Billed Charges,13.18,85,,10.544,percent of total Billed Charges,85% of total Billed Charges,12.4,80,,9.92,percent of total Billed Charges,80% of total Billed Charges,9.61,62,,7.688,percent of total Billed Charges,62% of total Billed Charges,9.77,63,,7.816,percent of total Billed Charges,63% of total Billed Charges,9.61,62,,7.688,percent of total Billed Charges,62% of total Billed Charges,9.77,63,,7.816,percent of total billed charges,63% of total Billed Charges,9.61,62,,7.688,percent of total Billed Charges,62% of total Billed Charges,12.4,80,,9.92,percent of total Billed Charges,80% of Total Billed Charges,9.61,62,,7.688,percent of total Billed Charges,62% of total Billed Charges,9.61,62,,7.688,percent of total Billed Charges,62% of total Billed Charges,9.61,13.18,
Medical/surgical sterile supply,72119,CDM,272,RC,,,Outpatient,,,10,7,,8,80,,6.4,percent of total Billed Charges,80% of Total Billed Charges,6.3,63,,5.04,percent of total Billed charges,63% of Total Billed Charges,6.2,62,,4.96,percent of total Billed Charges,62% of total BIlled charges,6.3,63,,5.04,percent of total Billed Charges,63% of total Billed Charges,8.5,85,,6.8,percent of total Billed Charges,85% of total Billed Charges,8,80,,6.4,percent of total Billed Charges,80% of total Billed Charges,6.2,62,,4.96,percent of total Billed Charges,62% of total Billed Charges,6.3,63,,5.04,percent of total Billed Charges,63% of total Billed Charges,6.2,62,,4.96,percent of total Billed Charges,62% of total Billed Charges,6.3,63,,5.04,percent of total billed charges,63% of total Billed Charges,6.2,62,,4.96,percent of total Billed Charges,62% of total Billed Charges,8,80,,6.4,percent of total Billed Charges,80% of Total Billed Charges,6.2,62,,4.96,percent of total Billed Charges,62% of total Billed Charges,6.2,62,,4.96,percent of total Billed Charges,62% of total Billed Charges,6.2,8.5,
Medical/surgical sterile supply,72116,CDM,272,RC,,,Outpatient,,,9.76,6.832,,7.81,80,,6.248,percent of total Billed Charges,80% of Total Billed Charges,6.15,63,,4.92,percent of total Billed charges,63% of Total Billed Charges,6.05,62,,4.84,percent of total Billed Charges,62% of total BIlled charges,6.15,63,,4.92,percent of total Billed Charges,63% of total Billed Charges,8.3,85,,6.64,percent of total Billed Charges,85% of total Billed Charges,7.81,80,,6.248,percent of total Billed Charges,80% of total Billed Charges,6.05,62,,4.84,percent of total Billed Charges,62% of total Billed Charges,6.15,63,,4.92,percent of total Billed Charges,63% of total Billed Charges,6.05,62,,4.84,percent of total Billed Charges,62% of total Billed Charges,6.15,63,,4.92,percent of total billed charges,63% of total Billed Charges,6.05,62,,4.84,percent of total Billed Charges,62% of total Billed Charges,7.81,80,,6.248,percent of total Billed Charges,80% of Total Billed Charges,6.05,62,,4.84,percent of total Billed Charges,62% of total Billed Charges,6.05,62,,4.84,percent of total Billed Charges,62% of total Billed Charges,6.05,8.3,
Medical/surgical sterile supply,72120,CDM,272,RC,,,Outpatient,,,15.5,10.85,,12.4,80,,9.92,percent of total Billed Charges,80% of Total Billed Charges,9.77,63,,7.816,percent of total Billed charges,63% of Total Billed Charges,9.61,62,,7.688,percent of total Billed Charges,62% of total BIlled charges,9.77,63,,7.816,percent of total Billed Charges,63% of total Billed Charges,13.18,85,,10.544,percent of total Billed Charges,85% of total Billed Charges,12.4,80,,9.92,percent of total Billed Charges,80% of total Billed Charges,9.61,62,,7.688,percent of total Billed Charges,62% of total Billed Charges,9.77,63,,7.816,percent of total Billed Charges,63% of total Billed Charges,9.61,62,,7.688,percent of total Billed Charges,62% of total Billed Charges,9.77,63,,7.816,percent of total billed charges,63% of total Billed Charges,9.61,62,,7.688,percent of total Billed Charges,62% of total Billed Charges,12.4,80,,9.92,percent of total Billed Charges,80% of Total Billed Charges,9.61,62,,7.688,percent of total Billed Charges,62% of total Billed Charges,9.61,62,,7.688,percent of total Billed Charges,62% of total Billed Charges,9.61,13.18,
Medical/surgical sterile supply,72222,CDM,272,RC,,,Outpatient,,,14.5,10.15,,11.6,80,,9.28,percent of total Billed Charges,80% of Total Billed Charges,9.14,63,,7.312,percent of total Billed charges,63% of Total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total BIlled charges,9.14,63,,7.312,percent of total Billed Charges,63% of total Billed Charges,12.33,85,,9.864,percent of total Billed Charges,85% of total Billed Charges,11.6,80,,9.28,percent of total Billed Charges,80% of total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total Billed Charges,9.14,63,,7.312,percent of total Billed Charges,63% of total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total Billed Charges,9.14,63,,7.312,percent of total billed charges,63% of total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total Billed Charges,11.6,80,,9.28,percent of total Billed Charges,80% of Total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total Billed Charges,8.99,62,,7.192,percent of total Billed Charges,62% of total Billed Charges,8.99,12.33,
Medical/surgical sterile supply,71581,CDM,272,RC,,,Outpatient,,,736.67,515.669,,589.34,80,,471.472,percent of total Billed Charges,80% of Total Billed Charges,464.1,63,,371.28,percent of total Billed charges,63% of Total Billed Charges,456.74,62,,365.392,percent of total Billed Charges,62% of total BIlled charges,464.1,63,,371.28,percent of total Billed Charges,63% of total Billed Charges,626.17,85,,500.936,percent of total Billed Charges,85% of total Billed Charges,589.34,80,,471.472,percent of total Billed Charges,80% of total Billed Charges,456.74,62,,365.392,percent of total Billed Charges,62% of total Billed Charges,464.1,63,,371.28,percent of total Billed Charges,63% of total Billed Charges,456.74,62,,365.392,percent of total Billed Charges,62% of total Billed Charges,464.1,63,,371.28,percent of total billed charges,63% of total Billed Charges,456.74,62,,365.392,percent of total Billed Charges,62% of total Billed Charges,589.34,80,,471.472,percent of total Billed Charges,80% of Total Billed Charges,456.74,62,,365.392,percent of total Billed Charges,62% of total Billed Charges,456.74,62,,365.392,percent of total Billed Charges,62% of total Billed Charges,456.74,626.17,
Medical/surgical sterile supply,71720,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72052,CDM,272,RC,,,Outpatient,,,27.5,19.25,,22,80,,17.6,percent of total Billed Charges,80% of Total Billed Charges,17.33,63,,13.864,percent of total Billed charges,63% of Total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total BIlled charges,17.33,63,,13.864,percent of total Billed Charges,63% of total Billed Charges,23.38,85,,18.704,percent of total Billed Charges,85% of total Billed Charges,22,80,,17.6,percent of total Billed Charges,80% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.33,63,,13.864,percent of total Billed Charges,63% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.33,63,,13.864,percent of total billed charges,63% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,22,80,,17.6,percent of total Billed Charges,80% of Total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.05,23.38,
Medical/surgical sterile supply,72053,CDM,272,RC,,,Outpatient,,,26.04,18.228,,20.83,80,,16.664,percent of total Billed Charges,80% of Total Billed Charges,16.41,63,,13.128,percent of total Billed charges,63% of Total Billed Charges,16.14,62,,12.912,percent of total Billed Charges,62% of total BIlled charges,16.41,63,,13.128,percent of total Billed Charges,63% of total Billed Charges,22.13,85,,17.704,percent of total Billed Charges,85% of total Billed Charges,20.83,80,,16.664,percent of total Billed Charges,80% of total Billed Charges,16.14,62,,12.912,percent of total Billed Charges,62% of total Billed Charges,16.41,63,,13.128,percent of total Billed Charges,63% of total Billed Charges,16.14,62,,12.912,percent of total Billed Charges,62% of total Billed Charges,16.41,63,,13.128,percent of total billed charges,63% of total Billed Charges,16.14,62,,12.912,percent of total Billed Charges,62% of total Billed Charges,20.83,80,,16.664,percent of total Billed Charges,80% of Total Billed Charges,16.14,62,,12.912,percent of total Billed Charges,62% of total Billed Charges,16.14,62,,12.912,percent of total Billed Charges,62% of total Billed Charges,16.14,22.13,
Medical/surgical sterile supply,70136,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72026,CDM,272,RC,,,Outpatient,,,84,58.8,,67.2,80,,53.76,percent of total Billed Charges,80% of Total Billed Charges,52.92,63,,42.336,percent of total Billed charges,63% of Total Billed Charges,52.08,62,,41.664,percent of total Billed Charges,62% of total BIlled charges,52.92,63,,42.336,percent of total Billed Charges,63% of total Billed Charges,71.4,85,,57.12,percent of total Billed Charges,85% of total Billed Charges,67.2,80,,53.76,percent of total Billed Charges,80% of total Billed Charges,52.08,62,,41.664,percent of total Billed Charges,62% of total Billed Charges,52.92,63,,42.336,percent of total Billed Charges,63% of total Billed Charges,52.08,62,,41.664,percent of total Billed Charges,62% of total Billed Charges,52.92,63,,42.336,percent of total billed charges,63% of total Billed Charges,52.08,62,,41.664,percent of total Billed Charges,62% of total Billed Charges,67.2,80,,53.76,percent of total Billed Charges,80% of Total Billed Charges,52.08,62,,41.664,percent of total Billed Charges,62% of total Billed Charges,52.08,62,,41.664,percent of total Billed Charges,62% of total Billed Charges,52.08,71.4,
Medical/surgical sterile supply,72028,CDM,272,RC,,,Outpatient,,,81.27,56.889,,65.02,80,,52.016,percent of total Billed Charges,80% of Total Billed Charges,51.2,63,,40.96,percent of total Billed charges,63% of Total Billed Charges,50.39,62,,40.312,percent of total Billed Charges,62% of total BIlled charges,51.2,63,,40.96,percent of total Billed Charges,63% of total Billed Charges,69.08,85,,55.264,percent of total Billed Charges,85% of total Billed Charges,65.02,80,,52.016,percent of total Billed Charges,80% of total Billed Charges,50.39,62,,40.312,percent of total Billed Charges,62% of total Billed Charges,51.2,63,,40.96,percent of total Billed Charges,63% of total Billed Charges,50.39,62,,40.312,percent of total Billed Charges,62% of total Billed Charges,51.2,63,,40.96,percent of total billed charges,63% of total Billed Charges,50.39,62,,40.312,percent of total Billed Charges,62% of total Billed Charges,65.02,80,,52.016,percent of total Billed Charges,80% of Total Billed Charges,50.39,62,,40.312,percent of total Billed Charges,62% of total Billed Charges,50.39,62,,40.312,percent of total Billed Charges,62% of total Billed Charges,50.39,69.08,
Medical/surgical sterile supply,72025,CDM,272,RC,,,Outpatient,,,87.33,61.131,,69.86,80,,55.888,percent of total Billed Charges,80% of Total Billed Charges,55.02,63,,44.016,percent of total Billed charges,63% of Total Billed Charges,54.14,62,,43.312,percent of total Billed Charges,62% of total BIlled charges,55.02,63,,44.016,percent of total Billed Charges,63% of total Billed Charges,74.23,85,,59.384,percent of total Billed Charges,85% of total Billed Charges,69.86,80,,55.888,percent of total Billed Charges,80% of total Billed Charges,54.14,62,,43.312,percent of total Billed Charges,62% of total Billed Charges,55.02,63,,44.016,percent of total Billed Charges,63% of total Billed Charges,54.14,62,,43.312,percent of total Billed Charges,62% of total Billed Charges,55.02,63,,44.016,percent of total billed charges,63% of total Billed Charges,54.14,62,,43.312,percent of total Billed Charges,62% of total Billed Charges,69.86,80,,55.888,percent of total Billed Charges,80% of Total Billed Charges,54.14,62,,43.312,percent of total Billed Charges,62% of total Billed Charges,54.14,62,,43.312,percent of total Billed Charges,62% of total Billed Charges,54.14,74.23,
Medical/surgical sterile supply,71105,CDM,272,RC,,,Outpatient,,,6.83,4.781,,5.46,80,,4.368,percent of total Billed Charges,80% of Total Billed Charges,4.3,63,,3.44,percent of total Billed charges,63% of Total Billed Charges,4.23,62,,3.384,percent of total Billed Charges,62% of total BIlled charges,4.3,63,,3.44,percent of total Billed Charges,63% of total Billed Charges,5.81,85,,4.648,percent of total Billed Charges,85% of total Billed Charges,5.46,80,,4.368,percent of total Billed Charges,80% of total Billed Charges,4.23,62,,3.384,percent of total Billed Charges,62% of total Billed Charges,4.3,63,,3.44,percent of total Billed Charges,63% of total Billed Charges,4.23,62,,3.384,percent of total Billed Charges,62% of total Billed Charges,4.3,63,,3.44,percent of total billed charges,63% of total Billed Charges,4.23,62,,3.384,percent of total Billed Charges,62% of total Billed Charges,5.46,80,,4.368,percent of total Billed Charges,80% of Total Billed Charges,4.23,62,,3.384,percent of total Billed Charges,62% of total Billed Charges,4.23,62,,3.384,percent of total Billed Charges,62% of total Billed Charges,4.23,5.81,
Medical/surgical sterile supply,72036,CDM,272,RC,,,Outpatient,,,22.33,15.631,,17.86,80,,14.288,percent of total Billed Charges,80% of Total Billed Charges,14.07,63,,11.256,percent of total Billed charges,63% of Total Billed Charges,13.84,62,,11.072,percent of total Billed Charges,62% of total BIlled charges,14.07,63,,11.256,percent of total Billed Charges,63% of total Billed Charges,18.98,85,,15.184,percent of total Billed Charges,85% of total Billed Charges,17.86,80,,14.288,percent of total Billed Charges,80% of total Billed Charges,13.84,62,,11.072,percent of total Billed Charges,62% of total Billed Charges,14.07,63,,11.256,percent of total Billed Charges,63% of total Billed Charges,13.84,62,,11.072,percent of total Billed Charges,62% of total Billed Charges,14.07,63,,11.256,percent of total billed charges,63% of total Billed Charges,13.84,62,,11.072,percent of total Billed Charges,62% of total Billed Charges,17.86,80,,14.288,percent of total Billed Charges,80% of Total Billed Charges,13.84,62,,11.072,percent of total Billed Charges,62% of total Billed Charges,13.84,62,,11.072,percent of total Billed Charges,62% of total Billed Charges,13.84,18.98,
Medical/surgical sterile supply,72021,CDM,272,RC,,,Outpatient,,,24.64,17.248,,19.71,80,,15.768,percent of total Billed Charges,80% of Total Billed Charges,15.52,63,,12.416,percent of total Billed charges,63% of Total Billed Charges,15.28,62,,12.224,percent of total Billed Charges,62% of total BIlled charges,15.52,63,,12.416,percent of total Billed Charges,63% of total Billed Charges,20.94,85,,16.752,percent of total Billed Charges,85% of total Billed Charges,19.71,80,,15.768,percent of total Billed Charges,80% of total Billed Charges,15.28,62,,12.224,percent of total Billed Charges,62% of total Billed Charges,15.52,63,,12.416,percent of total Billed Charges,63% of total Billed Charges,15.28,62,,12.224,percent of total Billed Charges,62% of total Billed Charges,15.52,63,,12.416,percent of total billed charges,63% of total Billed Charges,15.28,62,,12.224,percent of total Billed Charges,62% of total Billed Charges,19.71,80,,15.768,percent of total Billed Charges,80% of Total Billed Charges,15.28,62,,12.224,percent of total Billed Charges,62% of total Billed Charges,15.28,62,,12.224,percent of total Billed Charges,62% of total Billed Charges,15.28,20.94,
Medical/surgical sterile supply,72325,CDM,272,RC,,,Outpatient,,,81.39,56.973,,65.11,80,,52.088,percent of total Billed Charges,80% of Total Billed Charges,51.28,63,,41.024,percent of total Billed charges,63% of Total Billed Charges,50.46,62,,40.368,percent of total Billed Charges,62% of total BIlled charges,51.28,63,,41.024,percent of total Billed Charges,63% of total Billed Charges,69.18,85,,55.344,percent of total Billed Charges,85% of total Billed Charges,65.11,80,,52.088,percent of total Billed Charges,80% of total Billed Charges,50.46,62,,40.368,percent of total Billed Charges,62% of total Billed Charges,51.28,63,,41.024,percent of total Billed Charges,63% of total Billed Charges,50.46,62,,40.368,percent of total Billed Charges,62% of total Billed Charges,51.28,63,,41.024,percent of total billed charges,63% of total Billed Charges,50.46,62,,40.368,percent of total Billed Charges,62% of total Billed Charges,65.11,80,,52.088,percent of total Billed Charges,80% of Total Billed Charges,50.46,62,,40.368,percent of total Billed Charges,62% of total Billed Charges,50.46,62,,40.368,percent of total Billed Charges,62% of total Billed Charges,50.46,69.18,
Medical/surgical sterile supply,72366,CDM,272,RC,,,Outpatient,,,26.04,18.228,,20.83,80,,16.664,percent of total Billed Charges,80% of Total Billed Charges,16.41,63,,13.128,percent of total Billed charges,63% of Total Billed Charges,16.14,62,,12.912,percent of total Billed Charges,62% of total BIlled charges,16.41,63,,13.128,percent of total Billed Charges,63% of total Billed Charges,22.13,85,,17.704,percent of total Billed Charges,85% of total Billed Charges,20.83,80,,16.664,percent of total Billed Charges,80% of total Billed Charges,16.14,62,,12.912,percent of total Billed Charges,62% of total Billed Charges,16.41,63,,13.128,percent of total Billed Charges,63% of total Billed Charges,16.14,62,,12.912,percent of total Billed Charges,62% of total Billed Charges,16.41,63,,13.128,percent of total billed charges,63% of total Billed Charges,16.14,62,,12.912,percent of total Billed Charges,62% of total Billed Charges,20.83,80,,16.664,percent of total Billed Charges,80% of Total Billed Charges,16.14,62,,12.912,percent of total Billed Charges,62% of total Billed Charges,16.14,62,,12.912,percent of total Billed Charges,62% of total Billed Charges,16.14,22.13,
Medical/surgical sterile supply,70250,CDM,272,RC,,,Outpatient,,,27.5,19.25,,22,80,,17.6,percent of total Billed Charges,80% of Total Billed Charges,17.33,63,,13.864,percent of total Billed charges,63% of Total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total BIlled charges,17.33,63,,13.864,percent of total Billed Charges,63% of total Billed Charges,23.38,85,,18.704,percent of total Billed Charges,85% of total Billed Charges,22,80,,17.6,percent of total Billed Charges,80% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.33,63,,13.864,percent of total Billed Charges,63% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.33,63,,13.864,percent of total billed charges,63% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,22,80,,17.6,percent of total Billed Charges,80% of Total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.05,23.38,
Medical/surgical sterile supply,72051,CDM,272,RC,,,Outpatient,,,27.5,19.25,,22,80,,17.6,percent of total Billed Charges,80% of Total Billed Charges,17.33,63,,13.864,percent of total Billed charges,63% of Total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total BIlled charges,17.33,63,,13.864,percent of total Billed Charges,63% of total Billed Charges,23.38,85,,18.704,percent of total Billed Charges,85% of total Billed Charges,22,80,,17.6,percent of total Billed Charges,80% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.33,63,,13.864,percent of total Billed Charges,63% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.33,63,,13.864,percent of total billed charges,63% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,22,80,,17.6,percent of total Billed Charges,80% of Total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.05,62,,13.64,percent of total Billed Charges,62% of total Billed Charges,17.05,23.38,
Medical/surgical sterile supply,72011,CDM,272,RC,,,Outpatient,,,40,28,,32,80,,25.6,percent of total Billed Charges,80% of Total Billed Charges,25.2,63,,20.16,percent of total Billed charges,63% of Total Billed Charges,24.8,62,,19.84,percent of total Billed Charges,62% of total BIlled charges,25.2,63,,20.16,percent of total Billed Charges,63% of total Billed Charges,34,85,,27.2,percent of total Billed Charges,85% of total Billed Charges,32,80,,25.6,percent of total Billed Charges,80% of total Billed Charges,24.8,62,,19.84,percent of total Billed Charges,62% of total Billed Charges,25.2,63,,20.16,percent of total Billed Charges,63% of total Billed Charges,24.8,62,,19.84,percent of total Billed Charges,62% of total Billed Charges,25.2,63,,20.16,percent of total billed charges,63% of total Billed Charges,24.8,62,,19.84,percent of total Billed Charges,62% of total Billed Charges,32,80,,25.6,percent of total Billed Charges,80% of Total Billed Charges,24.8,62,,19.84,percent of total Billed Charges,62% of total Billed Charges,24.8,62,,19.84,percent of total Billed Charges,62% of total Billed Charges,24.8,34,
Medical/surgical sterile supply,72216,CDM,272,RC,,,Outpatient,,,62,43.4,,49.6,80,,39.68,percent of total Billed Charges,80% of Total Billed Charges,39.06,63,,31.248,percent of total Billed charges,63% of Total Billed Charges,38.44,62,,30.752,percent of total Billed Charges,62% of total BIlled charges,39.06,63,,31.248,percent of total Billed Charges,63% of total Billed Charges,52.7,85,,42.16,percent of total Billed Charges,85% of total Billed Charges,49.6,80,,39.68,percent of total Billed Charges,80% of total Billed Charges,38.44,62,,30.752,percent of total Billed Charges,62% of total Billed Charges,39.06,63,,31.248,percent of total Billed Charges,63% of total Billed Charges,38.44,62,,30.752,percent of total Billed Charges,62% of total Billed Charges,39.06,63,,31.248,percent of total billed charges,63% of total Billed Charges,38.44,62,,30.752,percent of total Billed Charges,62% of total Billed Charges,49.6,80,,39.68,percent of total Billed Charges,80% of Total Billed Charges,38.44,62,,30.752,percent of total Billed Charges,62% of total Billed Charges,38.44,62,,30.752,percent of total Billed Charges,62% of total Billed Charges,38.44,52.7,
Medical/surgical sterile supply,72192,CDM,272,RC,,,Outpatient,,,74.55,52.185,,59.64,80,,47.712,percent of total Billed Charges,80% of Total Billed Charges,46.97,63,,37.576,percent of total Billed charges,63% of Total Billed Charges,46.22,62,,36.976,percent of total Billed Charges,62% of total BIlled charges,46.97,63,,37.576,percent of total Billed Charges,63% of total Billed Charges,63.37,85,,50.696,percent of total Billed Charges,85% of total Billed Charges,59.64,80,,47.712,percent of total Billed Charges,80% of total Billed Charges,46.22,62,,36.976,percent of total Billed Charges,62% of total Billed Charges,46.97,63,,37.576,percent of total Billed Charges,63% of total Billed Charges,46.22,62,,36.976,percent of total Billed Charges,62% of total Billed Charges,46.97,63,,37.576,percent of total billed charges,63% of total Billed Charges,46.22,62,,36.976,percent of total Billed Charges,62% of total Billed Charges,59.64,80,,47.712,percent of total Billed Charges,80% of Total Billed Charges,46.22,62,,36.976,percent of total Billed Charges,62% of total Billed Charges,46.22,62,,36.976,percent of total Billed Charges,62% of total Billed Charges,46.22,63.37,
Medical/surgical sterile supply,72198,CDM,272,RC,,,Outpatient,,,13.5,9.45,,10.8,80,,8.64,percent of total Billed Charges,80% of Total Billed Charges,8.51,63,,6.808,percent of total Billed charges,63% of Total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total BIlled charges,8.51,63,,6.808,percent of total Billed Charges,63% of total Billed Charges,11.48,85,,9.184,percent of total Billed Charges,85% of total Billed Charges,10.8,80,,8.64,percent of total Billed Charges,80% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.51,63,,6.808,percent of total Billed Charges,63% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.51,63,,6.808,percent of total billed charges,63% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,10.8,80,,8.64,percent of total Billed Charges,80% of Total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.37,62,,6.696,percent of total Billed Charges,62% of total Billed Charges,8.37,11.48,
Medical/surgical sterile supply,72238,CDM,272,RC,,,Outpatient,,,348.54,243.978,,278.83,80,,223.064,percent of total Billed Charges,80% of Total Billed Charges,219.58,63,,175.664,percent of total Billed charges,63% of Total Billed Charges,216.09,62,,172.872,percent of total Billed Charges,62% of total BIlled charges,219.58,63,,175.664,percent of total Billed Charges,63% of total Billed Charges,296.26,85,,237.008,percent of total Billed Charges,85% of total Billed Charges,278.83,80,,223.064,percent of total Billed Charges,80% of total Billed Charges,216.09,62,,172.872,percent of total Billed Charges,62% of total Billed Charges,219.58,63,,175.664,percent of total Billed Charges,63% of total Billed Charges,216.09,62,,172.872,percent of total Billed Charges,62% of total Billed Charges,219.58,63,,175.664,percent of total billed charges,63% of total Billed Charges,216.09,62,,172.872,percent of total Billed Charges,62% of total Billed Charges,278.83,80,,223.064,percent of total Billed Charges,80% of Total Billed Charges,216.09,62,,172.872,percent of total Billed Charges,62% of total Billed Charges,216.09,62,,172.872,percent of total Billed Charges,62% of total Billed Charges,216.09,296.26,
Medical/surgical sterile supply,72224,CDM,272,RC,,,Outpatient,,,13.27,9.289,,10.62,80,,8.496,percent of total Billed Charges,80% of Total Billed Charges,8.36,63,,6.688,percent of total Billed charges,63% of Total Billed Charges,8.23,62,,6.584,percent of total Billed Charges,62% of total BIlled charges,8.36,63,,6.688,percent of total Billed Charges,63% of total Billed Charges,11.28,85,,9.024,percent of total Billed Charges,85% of total Billed Charges,10.62,80,,8.496,percent of total Billed Charges,80% of total Billed Charges,8.23,62,,6.584,percent of total Billed Charges,62% of total Billed Charges,8.36,63,,6.688,percent of total Billed Charges,63% of total Billed Charges,8.23,62,,6.584,percent of total Billed Charges,62% of total Billed Charges,8.36,63,,6.688,percent of total billed charges,63% of total Billed Charges,8.23,62,,6.584,percent of total Billed Charges,62% of total Billed Charges,10.62,80,,8.496,percent of total Billed Charges,80% of Total Billed Charges,8.23,62,,6.584,percent of total Billed Charges,62% of total Billed Charges,8.23,62,,6.584,percent of total Billed Charges,62% of total Billed Charges,8.23,11.28,
Medical/surgical sterile supply,72223,CDM,272,RC,,,Outpatient,,,22.5,15.75,,18,80,,14.4,percent of total Billed Charges,80% of Total Billed Charges,14.18,63,,11.344,percent of total Billed charges,63% of Total Billed Charges,13.95,62,,11.16,percent of total Billed Charges,62% of total BIlled charges,14.18,63,,11.344,percent of total Billed Charges,63% of total Billed Charges,19.13,85,,15.304,percent of total Billed Charges,85% of total Billed Charges,18,80,,14.4,percent of total Billed Charges,80% of total Billed Charges,13.95,62,,11.16,percent of total Billed Charges,62% of total Billed Charges,14.18,63,,11.344,percent of total Billed Charges,63% of total Billed Charges,13.95,62,,11.16,percent of total Billed Charges,62% of total Billed Charges,14.18,63,,11.344,percent of total billed charges,63% of total Billed Charges,13.95,62,,11.16,percent of total Billed Charges,62% of total Billed Charges,18,80,,14.4,percent of total Billed Charges,80% of Total Billed Charges,13.95,62,,11.16,percent of total Billed Charges,62% of total Billed Charges,13.95,62,,11.16,percent of total Billed Charges,62% of total Billed Charges,13.95,19.13,
Medical/surgical sterile supply,71069,CDM,272,RC,,,Outpatient,,,6.3,4.41,,5.04,80,,4.032,percent of total Billed Charges,80% of Total Billed Charges,3.97,63,,3.176,percent of total Billed charges,63% of Total Billed Charges,3.91,62,,3.128,percent of total Billed Charges,62% of total BIlled charges,3.97,63,,3.176,percent of total Billed Charges,63% of total Billed Charges,5.36,85,,4.288,percent of total Billed Charges,85% of total Billed Charges,5.04,80,,4.032,percent of total Billed Charges,80% of total Billed Charges,3.91,62,,3.128,percent of total Billed Charges,62% of total Billed Charges,3.97,63,,3.176,percent of total Billed Charges,63% of total Billed Charges,3.91,62,,3.128,percent of total Billed Charges,62% of total Billed Charges,3.97,63,,3.176,percent of total billed charges,63% of total Billed Charges,3.91,62,,3.128,percent of total Billed Charges,62% of total Billed Charges,5.04,80,,4.032,percent of total Billed Charges,80% of Total Billed Charges,3.91,62,,3.128,percent of total Billed Charges,62% of total Billed Charges,3.91,62,,3.128,percent of total Billed Charges,62% of total Billed Charges,3.91,5.36,
Medical/surgical sterile supply,71068,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72031,CDM,272,RC,,,Outpatient,,,59.5,41.65,,47.6,80,,38.08,percent of total Billed Charges,80% of Total Billed Charges,37.49,63,,29.992,percent of total Billed charges,63% of Total Billed Charges,36.89,62,,29.512,percent of total Billed Charges,62% of total BIlled charges,37.49,63,,29.992,percent of total Billed Charges,63% of total Billed Charges,50.58,85,,40.464,percent of total Billed Charges,85% of total Billed Charges,47.6,80,,38.08,percent of total Billed Charges,80% of total Billed Charges,36.89,62,,29.512,percent of total Billed Charges,62% of total Billed Charges,37.49,63,,29.992,percent of total Billed Charges,63% of total Billed Charges,36.89,62,,29.512,percent of total Billed Charges,62% of total Billed Charges,37.49,63,,29.992,percent of total billed charges,63% of total Billed Charges,36.89,62,,29.512,percent of total Billed Charges,62% of total Billed Charges,47.6,80,,38.08,percent of total Billed Charges,80% of Total Billed Charges,36.89,62,,29.512,percent of total Billed Charges,62% of total Billed Charges,36.89,62,,29.512,percent of total Billed Charges,62% of total Billed Charges,36.89,50.58,
Medical/surgical sterile supply,72030,CDM,272,RC,,,Outpatient,,,53.62,37.534,,42.9,80,,34.32,percent of total Billed Charges,80% of Total Billed Charges,33.78,63,,27.024,percent of total Billed charges,63% of Total Billed Charges,33.24,62,,26.592,percent of total Billed Charges,62% of total BIlled charges,33.78,63,,27.024,percent of total Billed Charges,63% of total Billed Charges,45.58,85,,36.464,percent of total Billed Charges,85% of total Billed Charges,42.9,80,,34.32,percent of total Billed Charges,80% of total Billed Charges,33.24,62,,26.592,percent of total Billed Charges,62% of total Billed Charges,33.78,63,,27.024,percent of total Billed Charges,63% of total Billed Charges,33.24,62,,26.592,percent of total Billed Charges,62% of total Billed Charges,33.78,63,,27.024,percent of total billed charges,63% of total Billed Charges,33.24,62,,26.592,percent of total Billed Charges,62% of total Billed Charges,42.9,80,,34.32,percent of total Billed Charges,80% of Total Billed Charges,33.24,62,,26.592,percent of total Billed Charges,62% of total Billed Charges,33.24,62,,26.592,percent of total Billed Charges,62% of total Billed Charges,33.24,45.58,
Medical/surgical sterile supply,72219,CDM,272,RC,,,Outpatient,,,83,58.1,,66.4,80,,53.12,percent of total Billed Charges,80% of Total Billed Charges,52.29,63,,41.832,percent of total Billed charges,63% of Total Billed Charges,51.46,62,,41.168,percent of total Billed Charges,62% of total BIlled charges,52.29,63,,41.832,percent of total Billed Charges,63% of total Billed Charges,70.55,85,,56.44,percent of total Billed Charges,85% of total Billed Charges,66.4,80,,53.12,percent of total Billed Charges,80% of total Billed Charges,51.46,62,,41.168,percent of total Billed Charges,62% of total Billed Charges,52.29,63,,41.832,percent of total Billed Charges,63% of total Billed Charges,51.46,62,,41.168,percent of total Billed Charges,62% of total Billed Charges,52.29,63,,41.832,percent of total billed charges,63% of total Billed Charges,51.46,62,,41.168,percent of total Billed Charges,62% of total Billed Charges,66.4,80,,53.12,percent of total Billed Charges,80% of Total Billed Charges,51.46,62,,41.168,percent of total Billed Charges,62% of total Billed Charges,51.46,62,,41.168,percent of total Billed Charges,62% of total Billed Charges,51.46,70.55,
Medical/surgical sterile supply,72220,CDM,272,RC,,,Outpatient,,,82,57.4,,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,51.66,63,,41.328,percent of total Billed charges,63% of Total Billed Charges,50.84,62,,40.672,percent of total Billed Charges,62% of total BIlled charges,51.66,63,,41.328,percent of total Billed Charges,63% of total Billed Charges,69.7,85,,55.76,percent of total Billed Charges,85% of total Billed Charges,65.6,80,,52.48,percent of total Billed Charges,80% of total Billed Charges,50.84,62,,40.672,percent of total Billed Charges,62% of total Billed Charges,51.66,63,,41.328,percent of total Billed Charges,63% of total Billed Charges,50.84,62,,40.672,percent of total Billed Charges,62% of total Billed Charges,51.66,63,,41.328,percent of total billed charges,63% of total Billed Charges,50.84,62,,40.672,percent of total Billed Charges,62% of total Billed Charges,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,50.84,62,,40.672,percent of total Billed Charges,62% of total Billed Charges,50.84,62,,40.672,percent of total Billed Charges,62% of total Billed Charges,50.84,69.7,
Medical/surgical sterile supply,72355,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72356,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72213,CDM,272,RC,,,Outpatient,,,9.56,6.692,,7.65,80,,6.12,percent of total Billed Charges,80% of Total Billed Charges,6.02,63,,4.816,percent of total Billed charges,63% of Total Billed Charges,5.93,62,,4.744,percent of total Billed Charges,62% of total BIlled charges,6.02,63,,4.816,percent of total Billed Charges,63% of total Billed Charges,8.13,85,,6.504,percent of total Billed Charges,85% of total Billed Charges,7.65,80,,6.12,percent of total Billed Charges,80% of total Billed Charges,5.93,62,,4.744,percent of total Billed Charges,62% of total Billed Charges,6.02,63,,4.816,percent of total Billed Charges,63% of total Billed Charges,5.93,62,,4.744,percent of total Billed Charges,62% of total Billed Charges,6.02,63,,4.816,percent of total billed charges,63% of total Billed Charges,5.93,62,,4.744,percent of total Billed Charges,62% of total Billed Charges,7.65,80,,6.12,percent of total Billed Charges,80% of Total Billed Charges,5.93,62,,4.744,percent of total Billed Charges,62% of total Billed Charges,5.93,62,,4.744,percent of total Billed Charges,62% of total Billed Charges,5.93,8.13,
Medical/surgical sterile supply,70171,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,71619,CDM,272,RC,,,Outpatient,,,5.5,3.85,,4.4,80,,3.52,percent of total Billed Charges,80% of Total Billed Charges,3.47,63,,2.776,percent of total Billed charges,63% of Total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total BIlled charges,3.47,63,,2.776,percent of total Billed Charges,63% of total Billed Charges,4.68,85,,3.744,percent of total Billed Charges,85% of total Billed Charges,4.4,80,,3.52,percent of total Billed Charges,80% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.47,63,,2.776,percent of total Billed Charges,63% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.47,63,,2.776,percent of total billed charges,63% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,4.4,80,,3.52,percent of total Billed Charges,80% of Total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.41,62,,2.728,percent of total Billed Charges,62% of total Billed Charges,3.41,4.68,
Medical/surgical sterile supply,70906,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70265,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70901,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70902,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70903,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70904,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70908,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,71647,CDM,272,RC,,,Outpatient,,,34.55,24.185,,27.64,80,,22.112,percent of total Billed Charges,80% of Total Billed Charges,21.77,63,,17.416,percent of total Billed charges,63% of Total Billed Charges,21.42,62,,17.136,percent of total Billed Charges,62% of total BIlled charges,21.77,63,,17.416,percent of total Billed Charges,63% of total Billed Charges,29.37,85,,23.496,percent of total Billed Charges,85% of total Billed Charges,27.64,80,,22.112,percent of total Billed Charges,80% of total Billed Charges,21.42,62,,17.136,percent of total Billed Charges,62% of total Billed Charges,21.77,63,,17.416,percent of total Billed Charges,63% of total Billed Charges,21.42,62,,17.136,percent of total Billed Charges,62% of total Billed Charges,21.77,63,,17.416,percent of total billed charges,63% of total Billed Charges,21.42,62,,17.136,percent of total Billed Charges,62% of total Billed Charges,27.64,80,,22.112,percent of total Billed Charges,80% of Total Billed Charges,21.42,62,,17.136,percent of total Billed Charges,62% of total Billed Charges,21.42,62,,17.136,percent of total Billed Charges,62% of total Billed Charges,21.42,29.37,
Medical/surgical sterile supply,70535,CDM,272,RC,,,Outpatient,,,75.15,52.605,,60.12,80,,48.096,percent of total Billed Charges,80% of Total Billed Charges,47.34,63,,37.872,percent of total Billed charges,63% of Total Billed Charges,46.59,62,,37.272,percent of total Billed Charges,62% of total BIlled charges,47.34,63,,37.872,percent of total Billed Charges,63% of total Billed Charges,63.88,85,,51.104,percent of total Billed Charges,85% of total Billed Charges,60.12,80,,48.096,percent of total Billed Charges,80% of total Billed Charges,46.59,62,,37.272,percent of total Billed Charges,62% of total Billed Charges,47.34,63,,37.872,percent of total Billed Charges,63% of total Billed Charges,46.59,62,,37.272,percent of total Billed Charges,62% of total Billed Charges,47.34,63,,37.872,percent of total billed charges,63% of total Billed Charges,46.59,62,,37.272,percent of total Billed Charges,62% of total Billed Charges,60.12,80,,48.096,percent of total Billed Charges,80% of Total Billed Charges,46.59,62,,37.272,percent of total Billed Charges,62% of total Billed Charges,46.59,62,,37.272,percent of total Billed Charges,62% of total Billed Charges,46.59,63.88,
Medical/surgical sterile supply,71747,CDM,272,RC,,,Outpatient,,,84.47,59.129,,67.58,80,,54.064,percent of total Billed Charges,80% of Total Billed Charges,53.22,63,,42.576,percent of total Billed charges,63% of Total Billed Charges,52.37,62,,41.896,percent of total Billed Charges,62% of total BIlled charges,53.22,63,,42.576,percent of total Billed Charges,63% of total Billed Charges,71.8,85,,57.44,percent of total Billed Charges,85% of total Billed Charges,67.58,80,,54.064,percent of total Billed Charges,80% of total Billed Charges,52.37,62,,41.896,percent of total Billed Charges,62% of total Billed Charges,53.22,63,,42.576,percent of total Billed Charges,63% of total Billed Charges,52.37,62,,41.896,percent of total Billed Charges,62% of total Billed Charges,53.22,63,,42.576,percent of total billed charges,63% of total Billed Charges,52.37,62,,41.896,percent of total Billed Charges,62% of total Billed Charges,67.58,80,,54.064,percent of total Billed Charges,80% of Total Billed Charges,52.37,62,,41.896,percent of total Billed Charges,62% of total Billed Charges,52.37,62,,41.896,percent of total Billed Charges,62% of total Billed Charges,52.37,71.8,
Medical/surgical sterile supply,71828,CDM,272,RC,,,Outpatient,,,86.45,60.515,,69.16,80,,55.328,percent of total Billed Charges,80% of Total Billed Charges,54.46,63,,43.568,percent of total Billed charges,63% of Total Billed Charges,53.6,62,,42.88,percent of total Billed Charges,62% of total BIlled charges,54.46,63,,43.568,percent of total Billed Charges,63% of total Billed Charges,73.48,85,,58.784,percent of total Billed Charges,85% of total Billed Charges,69.16,80,,55.328,percent of total Billed Charges,80% of total Billed Charges,53.6,62,,42.88,percent of total Billed Charges,62% of total Billed Charges,54.46,63,,43.568,percent of total Billed Charges,63% of total Billed Charges,53.6,62,,42.88,percent of total Billed Charges,62% of total Billed Charges,54.46,63,,43.568,percent of total billed charges,63% of total Billed Charges,53.6,62,,42.88,percent of total Billed Charges,62% of total Billed Charges,69.16,80,,55.328,percent of total Billed Charges,80% of Total Billed Charges,53.6,62,,42.88,percent of total Billed Charges,62% of total Billed Charges,53.6,62,,42.88,percent of total Billed Charges,62% of total Billed Charges,53.6,73.48,
Medical/surgical sterile supply,70784,CDM,272,RC,,,Outpatient,,,9.49,6.643,,7.59,80,,6.072,percent of total Billed Charges,80% of Total Billed Charges,5.98,63,,4.784,percent of total Billed charges,63% of Total Billed Charges,5.88,62,,4.704,percent of total Billed Charges,62% of total BIlled charges,5.98,63,,4.784,percent of total Billed Charges,63% of total Billed Charges,8.07,85,,6.456,percent of total Billed Charges,85% of total Billed Charges,7.59,80,,6.072,percent of total Billed Charges,80% of total Billed Charges,5.88,62,,4.704,percent of total Billed Charges,62% of total Billed Charges,5.98,63,,4.784,percent of total Billed Charges,63% of total Billed Charges,5.88,62,,4.704,percent of total Billed Charges,62% of total Billed Charges,5.98,63,,4.784,percent of total billed charges,63% of total Billed Charges,5.88,62,,4.704,percent of total Billed Charges,62% of total Billed Charges,7.59,80,,6.072,percent of total Billed Charges,80% of Total Billed Charges,5.88,62,,4.704,percent of total Billed Charges,62% of total Billed Charges,5.88,62,,4.704,percent of total Billed Charges,62% of total Billed Charges,5.88,8.07,
Medical/surgical sterile supply,50063,CDM,272,RC,,,Outpatient,,,8.33,5.831,,6.66,80,,5.328,percent of total Billed Charges,80% of Total Billed Charges,5.25,63,,4.2,percent of total Billed charges,63% of Total Billed Charges,5.16,62,,4.128,percent of total Billed Charges,62% of total BIlled charges,5.25,63,,4.2,percent of total Billed Charges,63% of total Billed Charges,7.08,85,,5.664,percent of total Billed Charges,85% of total Billed Charges,6.66,80,,5.328,percent of total Billed Charges,80% of total Billed Charges,5.16,62,,4.128,percent of total Billed Charges,62% of total Billed Charges,5.25,63,,4.2,percent of total Billed Charges,63% of total Billed Charges,5.16,62,,4.128,percent of total Billed Charges,62% of total Billed Charges,5.25,63,,4.2,percent of total billed charges,63% of total Billed Charges,5.16,62,,4.128,percent of total Billed Charges,62% of total Billed Charges,6.66,80,,5.328,percent of total Billed Charges,80% of Total Billed Charges,5.16,62,,4.128,percent of total Billed Charges,62% of total Billed Charges,5.16,62,,4.128,percent of total Billed Charges,62% of total Billed Charges,5.16,7.08,
Medical/surgical sterile supply,72167,CDM,272,RC,,,Outpatient,,,40.64,28.448,,32.51,80,,26.008,percent of total Billed Charges,80% of Total Billed Charges,25.6,63,,20.48,percent of total Billed charges,63% of Total Billed Charges,25.2,62,,20.16,percent of total Billed Charges,62% of total BIlled charges,25.6,63,,20.48,percent of total Billed Charges,63% of total Billed Charges,34.54,85,,27.632,percent of total Billed Charges,85% of total Billed Charges,32.51,80,,26.008,percent of total Billed Charges,80% of total Billed Charges,25.2,62,,20.16,percent of total Billed Charges,62% of total Billed Charges,25.6,63,,20.48,percent of total Billed Charges,63% of total Billed Charges,25.2,62,,20.16,percent of total Billed Charges,62% of total Billed Charges,25.6,63,,20.48,percent of total billed charges,63% of total Billed Charges,25.2,62,,20.16,percent of total Billed Charges,62% of total Billed Charges,32.51,80,,26.008,percent of total Billed Charges,80% of Total Billed Charges,25.2,62,,20.16,percent of total Billed Charges,62% of total Billed Charges,25.2,62,,20.16,percent of total Billed Charges,62% of total Billed Charges,25.2,34.54,
Medical/surgical sterile supply,71849,CDM,272,RC,,,Outpatient,,,30,21,,24,80,,19.2,percent of total Billed Charges,80% of Total Billed Charges,18.9,63,,15.12,percent of total Billed charges,63% of Total Billed Charges,18.6,62,,14.88,percent of total Billed Charges,62% of total BIlled charges,18.9,63,,15.12,percent of total Billed Charges,63% of total Billed Charges,25.5,85,,20.4,percent of total Billed Charges,85% of total Billed Charges,24,80,,19.2,percent of total Billed Charges,80% of total Billed Charges,18.6,62,,14.88,percent of total Billed Charges,62% of total Billed Charges,18.9,63,,15.12,percent of total Billed Charges,63% of total Billed Charges,18.6,62,,14.88,percent of total Billed Charges,62% of total Billed Charges,18.9,63,,15.12,percent of total billed charges,63% of total Billed Charges,18.6,62,,14.88,percent of total Billed Charges,62% of total Billed Charges,24,80,,19.2,percent of total Billed Charges,80% of Total Billed Charges,18.6,62,,14.88,percent of total Billed Charges,62% of total Billed Charges,18.6,62,,14.88,percent of total Billed Charges,62% of total Billed Charges,18.6,25.5,
Medical/surgical sterile supply,71779,CDM,272,RC,,,Outpatient,,,284,198.8,,227.2,80,,181.76,percent of total Billed Charges,80% of Total Billed Charges,178.92,63,,143.136,percent of total Billed charges,63% of Total Billed Charges,176.08,62,,140.864,percent of total Billed Charges,62% of total BIlled charges,178.92,63,,143.136,percent of total Billed Charges,63% of total Billed Charges,241.4,85,,193.12,percent of total Billed Charges,85% of total Billed Charges,227.2,80,,181.76,percent of total Billed Charges,80% of total Billed Charges,176.08,62,,140.864,percent of total Billed Charges,62% of total Billed Charges,178.92,63,,143.136,percent of total Billed Charges,63% of total Billed Charges,176.08,62,,140.864,percent of total Billed Charges,62% of total Billed Charges,178.92,63,,143.136,percent of total billed charges,63% of total Billed Charges,176.08,62,,140.864,percent of total Billed Charges,62% of total Billed Charges,227.2,80,,181.76,percent of total Billed Charges,80% of Total Billed Charges,176.08,62,,140.864,percent of total Billed Charges,62% of total Billed Charges,176.08,62,,140.864,percent of total Billed Charges,62% of total Billed Charges,176.08,241.4,
Medical/surgical sterile supply,71567,CDM,272,RC,,,Outpatient,,,152.17,106.519,,121.74,80,,97.392,percent of total Billed Charges,80% of Total Billed Charges,95.87,63,,76.696,percent of total Billed charges,63% of Total Billed Charges,94.35,62,,75.48,percent of total Billed Charges,62% of total BIlled charges,95.87,63,,76.696,percent of total Billed Charges,63% of total Billed Charges,129.34,85,,103.472,percent of total Billed Charges,85% of total Billed Charges,121.74,80,,97.392,percent of total Billed Charges,80% of total Billed Charges,94.35,62,,75.48,percent of total Billed Charges,62% of total Billed Charges,95.87,63,,76.696,percent of total Billed Charges,63% of total Billed Charges,94.35,62,,75.48,percent of total Billed Charges,62% of total Billed Charges,95.87,63,,76.696,percent of total billed charges,63% of total Billed Charges,94.35,62,,75.48,percent of total Billed Charges,62% of total Billed Charges,121.74,80,,97.392,percent of total Billed Charges,80% of Total Billed Charges,94.35,62,,75.48,percent of total Billed Charges,62% of total Billed Charges,94.35,62,,75.48,percent of total Billed Charges,62% of total Billed Charges,94.35,129.34,
Medical/surgical sterile supply,71568,CDM,272,RC,,,Outpatient,,,156.88,109.816,,125.5,80,,100.4,percent of total Billed Charges,80% of Total Billed Charges,98.83,63,,79.064,percent of total Billed charges,63% of Total Billed Charges,97.27,62,,77.816,percent of total Billed Charges,62% of total BIlled charges,98.83,63,,79.064,percent of total Billed Charges,63% of total Billed Charges,133.35,85,,106.68,percent of total Billed Charges,85% of total Billed Charges,125.5,80,,100.4,percent of total Billed Charges,80% of total Billed Charges,97.27,62,,77.816,percent of total Billed Charges,62% of total Billed Charges,98.83,63,,79.064,percent of total Billed Charges,63% of total Billed Charges,97.27,62,,77.816,percent of total Billed Charges,62% of total Billed Charges,98.83,63,,79.064,percent of total billed charges,63% of total Billed Charges,97.27,62,,77.816,percent of total Billed Charges,62% of total Billed Charges,125.5,80,,100.4,percent of total Billed Charges,80% of Total Billed Charges,97.27,62,,77.816,percent of total Billed Charges,62% of total Billed Charges,97.27,62,,77.816,percent of total Billed Charges,62% of total Billed Charges,97.27,133.35,
Medical/surgical sterile supply,72009,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,71811,CDM,272,RC,,,Outpatient,,,270,189,,216,80,,172.8,percent of total Billed Charges,80% of Total Billed Charges,170.1,63,,136.08,percent of total Billed charges,63% of Total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total BIlled charges,170.1,63,,136.08,percent of total Billed Charges,63% of total Billed Charges,229.5,85,,183.6,percent of total Billed Charges,85% of total Billed Charges,216,80,,172.8,percent of total Billed Charges,80% of total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total Billed Charges,170.1,63,,136.08,percent of total Billed Charges,63% of total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total Billed Charges,170.1,63,,136.08,percent of total billed charges,63% of total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total Billed Charges,216,80,,172.8,percent of total Billed Charges,80% of Total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total Billed Charges,167.4,229.5,
Medical/surgical sterile supply,71755,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,71756,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70356,CDM,272,RC,,,Outpatient,,,98.51,68.957,,78.81,80,,63.048,percent of total Billed Charges,80% of Total Billed Charges,62.06,63,,49.648,percent of total Billed charges,63% of Total Billed Charges,61.08,62,,48.864,percent of total Billed Charges,62% of total BIlled charges,62.06,63,,49.648,percent of total Billed Charges,63% of total Billed Charges,83.73,85,,66.984,percent of total Billed Charges,85% of total Billed Charges,78.81,80,,63.048,percent of total Billed Charges,80% of total Billed Charges,61.08,62,,48.864,percent of total Billed Charges,62% of total Billed Charges,62.06,63,,49.648,percent of total Billed Charges,63% of total Billed Charges,61.08,62,,48.864,percent of total Billed Charges,62% of total Billed Charges,62.06,63,,49.648,percent of total billed charges,63% of total Billed Charges,61.08,62,,48.864,percent of total Billed Charges,62% of total Billed Charges,78.81,80,,63.048,percent of total Billed Charges,80% of Total Billed Charges,61.08,62,,48.864,percent of total Billed Charges,62% of total Billed Charges,61.08,62,,48.864,percent of total Billed Charges,62% of total Billed Charges,61.08,83.73,
Medical/surgical sterile supply,72307,CDM,272,RC,,,Outpatient,,,159.87,111.909,,127.9,80,,102.32,percent of total Billed Charges,80% of Total Billed Charges,100.72,63,,80.576,percent of total Billed charges,63% of Total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total BIlled charges,100.72,63,,80.576,percent of total Billed Charges,63% of total Billed Charges,135.89,85,,108.712,percent of total Billed Charges,85% of total Billed Charges,127.9,80,,102.32,percent of total Billed Charges,80% of total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,100.72,63,,80.576,percent of total Billed Charges,63% of total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,100.72,63,,80.576,percent of total billed charges,63% of total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,127.9,80,,102.32,percent of total Billed Charges,80% of Total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,99.12,135.89,
Medical/surgical sterile supply,70355,CDM,272,RC,,,Outpatient,,,98.51,68.957,,78.81,80,,63.048,percent of total Billed Charges,80% of Total Billed Charges,62.06,63,,49.648,percent of total Billed charges,63% of Total Billed Charges,61.08,62,,48.864,percent of total Billed Charges,62% of total BIlled charges,62.06,63,,49.648,percent of total Billed Charges,63% of total Billed Charges,83.73,85,,66.984,percent of total Billed Charges,85% of total Billed Charges,78.81,80,,63.048,percent of total Billed Charges,80% of total Billed Charges,61.08,62,,48.864,percent of total Billed Charges,62% of total Billed Charges,62.06,63,,49.648,percent of total Billed Charges,63% of total Billed Charges,61.08,62,,48.864,percent of total Billed Charges,62% of total Billed Charges,62.06,63,,49.648,percent of total billed charges,63% of total Billed Charges,61.08,62,,48.864,percent of total Billed Charges,62% of total Billed Charges,78.81,80,,63.048,percent of total Billed Charges,80% of Total Billed Charges,61.08,62,,48.864,percent of total Billed Charges,62% of total Billed Charges,61.08,62,,48.864,percent of total Billed Charges,62% of total Billed Charges,61.08,83.73,
Medical/surgical sterile supply,72304,CDM,272,RC,,,Outpatient,,,159.87,111.909,,127.9,80,,102.32,percent of total Billed Charges,80% of Total Billed Charges,100.72,63,,80.576,percent of total Billed charges,63% of Total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total BIlled charges,100.72,63,,80.576,percent of total Billed Charges,63% of total Billed Charges,135.89,85,,108.712,percent of total Billed Charges,85% of total Billed Charges,127.9,80,,102.32,percent of total Billed Charges,80% of total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,100.72,63,,80.576,percent of total Billed Charges,63% of total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,100.72,63,,80.576,percent of total billed charges,63% of total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,127.9,80,,102.32,percent of total Billed Charges,80% of Total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,99.12,135.89,
Medical/surgical sterile supply,72306,CDM,272,RC,,,Outpatient,,,159.87,111.909,,127.9,80,,102.32,percent of total Billed Charges,80% of Total Billed Charges,100.72,63,,80.576,percent of total Billed charges,63% of Total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total BIlled charges,100.72,63,,80.576,percent of total Billed Charges,63% of total Billed Charges,135.89,85,,108.712,percent of total Billed Charges,85% of total Billed Charges,127.9,80,,102.32,percent of total Billed Charges,80% of total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,100.72,63,,80.576,percent of total Billed Charges,63% of total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,100.72,63,,80.576,percent of total billed charges,63% of total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,127.9,80,,102.32,percent of total Billed Charges,80% of Total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,99.12,135.89,
Medical/surgical sterile supply,72303,CDM,272,RC,,,Outpatient,,,159.87,111.909,,127.9,80,,102.32,percent of total Billed Charges,80% of Total Billed Charges,100.72,63,,80.576,percent of total Billed charges,63% of Total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total BIlled charges,100.72,63,,80.576,percent of total Billed Charges,63% of total Billed Charges,135.89,85,,108.712,percent of total Billed Charges,85% of total Billed Charges,127.9,80,,102.32,percent of total Billed Charges,80% of total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,100.72,63,,80.576,percent of total Billed Charges,63% of total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,100.72,63,,80.576,percent of total billed charges,63% of total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,127.9,80,,102.32,percent of total Billed Charges,80% of Total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,99.12,62,,79.296,percent of total Billed Charges,62% of total Billed Charges,99.12,135.89,
Medical/surgical sterile supply,72040,CDM,272,RC,,,Outpatient,,,87.5,61.25,,70,80,,56,percent of total Billed Charges,80% of Total Billed Charges,55.13,63,,44.104,percent of total Billed charges,63% of Total Billed Charges,54.25,62,,43.4,percent of total Billed Charges,62% of total BIlled charges,55.13,63,,44.104,percent of total Billed Charges,63% of total Billed Charges,74.38,85,,59.504,percent of total Billed Charges,85% of total Billed Charges,70,80,,56,percent of total Billed Charges,80% of total Billed Charges,54.25,62,,43.4,percent of total Billed Charges,62% of total Billed Charges,55.13,63,,44.104,percent of total Billed Charges,63% of total Billed Charges,54.25,62,,43.4,percent of total Billed Charges,62% of total Billed Charges,55.13,63,,44.104,percent of total billed charges,63% of total Billed Charges,54.25,62,,43.4,percent of total Billed Charges,62% of total Billed Charges,70,80,,56,percent of total Billed Charges,80% of Total Billed Charges,54.25,62,,43.4,percent of total Billed Charges,62% of total Billed Charges,54.25,62,,43.4,percent of total Billed Charges,62% of total Billed Charges,54.25,74.38,
Medical/surgical sterile supply,71900,CDM,272,RC,,,Outpatient,,,21,14.7,,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.23,63,,10.584,percent of total Billed charges,63% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total BIlled charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,17.85,85,,14.28,percent of total Billed Charges,85% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total billed charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,17.85,
Medical/surgical sterile supply,70117,CDM,272,RC,,,Outpatient,,,14.35,10.045,,11.48,80,,9.184,percent of total Billed Charges,80% of Total Billed Charges,9.04,63,,7.232,percent of total Billed charges,63% of Total Billed Charges,8.9,62,,7.12,percent of total Billed Charges,62% of total BIlled charges,9.04,63,,7.232,percent of total Billed Charges,63% of total Billed Charges,12.2,85,,9.76,percent of total Billed Charges,85% of total Billed Charges,11.48,80,,9.184,percent of total Billed Charges,80% of total Billed Charges,8.9,62,,7.12,percent of total Billed Charges,62% of total Billed Charges,9.04,63,,7.232,percent of total Billed Charges,63% of total Billed Charges,8.9,62,,7.12,percent of total Billed Charges,62% of total Billed Charges,9.04,63,,7.232,percent of total billed charges,63% of total Billed Charges,8.9,62,,7.12,percent of total Billed Charges,62% of total Billed Charges,11.48,80,,9.184,percent of total Billed Charges,80% of Total Billed Charges,8.9,62,,7.12,percent of total Billed Charges,62% of total Billed Charges,8.9,62,,7.12,percent of total Billed Charges,62% of total Billed Charges,8.9,12.2,
Medical/surgical sterile supply,72157,CDM,272,RC,,,Outpatient,,,27.93,19.551,,22.34,80,,17.872,percent of total Billed Charges,80% of Total Billed Charges,17.6,63,,14.08,percent of total Billed charges,63% of Total Billed Charges,17.32,62,,13.856,percent of total Billed Charges,62% of total BIlled charges,17.6,63,,14.08,percent of total Billed Charges,63% of total Billed Charges,23.74,85,,18.992,percent of total Billed Charges,85% of total Billed Charges,22.34,80,,17.872,percent of total Billed Charges,80% of total Billed Charges,17.32,62,,13.856,percent of total Billed Charges,62% of total Billed Charges,17.6,63,,14.08,percent of total Billed Charges,63% of total Billed Charges,17.32,62,,13.856,percent of total Billed Charges,62% of total Billed Charges,17.6,63,,14.08,percent of total billed charges,63% of total Billed Charges,17.32,62,,13.856,percent of total Billed Charges,62% of total Billed Charges,22.34,80,,17.872,percent of total Billed Charges,80% of Total Billed Charges,17.32,62,,13.856,percent of total Billed Charges,62% of total Billed Charges,17.32,62,,13.856,percent of total Billed Charges,62% of total Billed Charges,17.32,23.74,
Medical/surgical sterile supply,71716,CDM,272,RC,,,Outpatient,,,16.03,11.221,,12.82,80,,10.256,percent of total Billed Charges,80% of Total Billed Charges,10.1,63,,8.08,percent of total Billed charges,63% of Total Billed Charges,9.94,62,,7.952,percent of total Billed Charges,62% of total BIlled charges,10.1,63,,8.08,percent of total Billed Charges,63% of total Billed Charges,13.63,85,,10.904,percent of total Billed Charges,85% of total Billed Charges,12.82,80,,10.256,percent of total Billed Charges,80% of total Billed Charges,9.94,62,,7.952,percent of total Billed Charges,62% of total Billed Charges,10.1,63,,8.08,percent of total Billed Charges,63% of total Billed Charges,9.94,62,,7.952,percent of total Billed Charges,62% of total Billed Charges,10.1,63,,8.08,percent of total billed charges,63% of total Billed Charges,9.94,62,,7.952,percent of total Billed Charges,62% of total Billed Charges,12.82,80,,10.256,percent of total Billed Charges,80% of Total Billed Charges,9.94,62,,7.952,percent of total Billed Charges,62% of total Billed Charges,9.94,62,,7.952,percent of total Billed Charges,62% of total Billed Charges,9.94,13.63,
Medical/surgical sterile supply,71818,CDM,272,RC,,,Outpatient,,,84.5,59.15,,67.6,80,,54.08,percent of total Billed Charges,80% of Total Billed Charges,53.24,63,,42.592,percent of total Billed charges,63% of Total Billed Charges,52.39,62,,41.912,percent of total Billed Charges,62% of total BIlled charges,53.24,63,,42.592,percent of total Billed Charges,63% of total Billed Charges,71.83,85,,57.464,percent of total Billed Charges,85% of total Billed Charges,67.6,80,,54.08,percent of total Billed Charges,80% of total Billed Charges,52.39,62,,41.912,percent of total Billed Charges,62% of total Billed Charges,53.24,63,,42.592,percent of total Billed Charges,63% of total Billed Charges,52.39,62,,41.912,percent of total Billed Charges,62% of total Billed Charges,53.24,63,,42.592,percent of total billed charges,63% of total Billed Charges,52.39,62,,41.912,percent of total Billed Charges,62% of total Billed Charges,67.6,80,,54.08,percent of total Billed Charges,80% of Total Billed Charges,52.39,62,,41.912,percent of total Billed Charges,62% of total Billed Charges,52.39,62,,41.912,percent of total Billed Charges,62% of total Billed Charges,52.39,71.83,
Medical/surgical sterile supply,71051,CDM,272,RC,,,Outpatient,,,5.18,3.626,,4.14,80,,3.312,percent of total Billed Charges,80% of Total Billed Charges,3.26,63,,2.608,percent of total Billed charges,63% of Total Billed Charges,3.21,62,,2.568,percent of total Billed Charges,62% of total BIlled charges,3.26,63,,2.608,percent of total Billed Charges,63% of total Billed Charges,4.4,85,,3.52,percent of total Billed Charges,85% of total Billed Charges,4.14,80,,3.312,percent of total Billed Charges,80% of total Billed Charges,3.21,62,,2.568,percent of total Billed Charges,62% of total Billed Charges,3.26,63,,2.608,percent of total Billed Charges,63% of total Billed Charges,3.21,62,,2.568,percent of total Billed Charges,62% of total Billed Charges,3.26,63,,2.608,percent of total billed charges,63% of total Billed Charges,3.21,62,,2.568,percent of total Billed Charges,62% of total Billed Charges,4.14,80,,3.312,percent of total Billed Charges,80% of Total Billed Charges,3.21,62,,2.568,percent of total Billed Charges,62% of total Billed Charges,3.21,62,,2.568,percent of total Billed Charges,62% of total Billed Charges,3.21,4.4,
Medical/surgical sterile supply,70188,CDM,272,RC,,,Outpatient,,,21,14.7,,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.23,63,,10.584,percent of total Billed charges,63% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total BIlled charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,17.85,85,,14.28,percent of total Billed Charges,85% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total billed charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,17.85,
Medical/surgical sterile supply,71540,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70123,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72326,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72327,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70257,CDM,272,RC,,,Outpatient,,,19.11,13.377,,15.29,80,,12.232,percent of total Billed Charges,80% of Total Billed Charges,12.04,63,,9.632,percent of total Billed charges,63% of Total Billed Charges,11.85,62,,9.48,percent of total Billed Charges,62% of total BIlled charges,12.04,63,,9.632,percent of total Billed Charges,63% of total Billed Charges,16.24,85,,12.992,percent of total Billed Charges,85% of total Billed Charges,15.29,80,,12.232,percent of total Billed Charges,80% of total Billed Charges,11.85,62,,9.48,percent of total Billed Charges,62% of total Billed Charges,12.04,63,,9.632,percent of total Billed Charges,63% of total Billed Charges,11.85,62,,9.48,percent of total Billed Charges,62% of total Billed Charges,12.04,63,,9.632,percent of total billed charges,63% of total Billed Charges,11.85,62,,9.48,percent of total Billed Charges,62% of total Billed Charges,15.29,80,,12.232,percent of total Billed Charges,80% of Total Billed Charges,11.85,62,,9.48,percent of total Billed Charges,62% of total Billed Charges,11.85,62,,9.48,percent of total Billed Charges,62% of total Billed Charges,11.85,16.24,
Medical/surgical sterile supply,70296,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72328,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72329,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70258,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70128,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70155,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70129,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70205,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,71844,CDM,272,RC,,,Outpatient,,,37.7,26.39,,30.16,80,,24.128,percent of total Billed Charges,80% of Total Billed Charges,23.75,63,,19,percent of total Billed charges,63% of Total Billed Charges,23.37,62,,18.696,percent of total Billed Charges,62% of total BIlled charges,23.75,63,,19,percent of total Billed Charges,63% of total Billed Charges,32.05,85,,25.64,percent of total Billed Charges,85% of total Billed Charges,30.16,80,,24.128,percent of total Billed Charges,80% of total Billed Charges,23.37,62,,18.696,percent of total Billed Charges,62% of total Billed Charges,23.75,63,,19,percent of total Billed Charges,63% of total Billed Charges,23.37,62,,18.696,percent of total Billed Charges,62% of total Billed Charges,23.75,63,,19,percent of total billed charges,63% of total Billed Charges,23.37,62,,18.696,percent of total Billed Charges,62% of total Billed Charges,30.16,80,,24.128,percent of total Billed Charges,80% of Total Billed Charges,23.37,62,,18.696,percent of total Billed Charges,62% of total Billed Charges,23.37,62,,18.696,percent of total Billed Charges,62% of total Billed Charges,23.37,32.05,
Medical/surgical sterile supply,72149,CDM,272,RC,,,Outpatient,,,17.55,12.285,,14.04,80,,11.232,percent of total Billed Charges,80% of Total Billed Charges,11.06,63,,8.848,percent of total Billed charges,63% of Total Billed Charges,10.88,62,,8.704,percent of total Billed Charges,62% of total BIlled charges,11.06,63,,8.848,percent of total Billed Charges,63% of total Billed Charges,14.92,85,,11.936,percent of total Billed Charges,85% of total Billed Charges,14.04,80,,11.232,percent of total Billed Charges,80% of total Billed Charges,10.88,62,,8.704,percent of total Billed Charges,62% of total Billed Charges,11.06,63,,8.848,percent of total Billed Charges,63% of total Billed Charges,10.88,62,,8.704,percent of total Billed Charges,62% of total Billed Charges,11.06,63,,8.848,percent of total billed charges,63% of total Billed Charges,10.88,62,,8.704,percent of total Billed Charges,62% of total Billed Charges,14.04,80,,11.232,percent of total Billed Charges,80% of Total Billed Charges,10.88,62,,8.704,percent of total Billed Charges,62% of total Billed Charges,10.88,62,,8.704,percent of total Billed Charges,62% of total Billed Charges,10.88,14.92,
Medical/surgical sterile supply,72080,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72158,CDM,272,RC,,,Outpatient,,,16,11.2,,12.8,80,,10.24,percent of total Billed Charges,80% of Total Billed Charges,10.08,63,,8.064,percent of total Billed charges,63% of Total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total BIlled charges,10.08,63,,8.064,percent of total Billed Charges,63% of total Billed Charges,13.6,85,,10.88,percent of total Billed Charges,85% of total Billed Charges,12.8,80,,10.24,percent of total Billed Charges,80% of total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total Billed Charges,10.08,63,,8.064,percent of total Billed Charges,63% of total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total Billed Charges,10.08,63,,8.064,percent of total billed charges,63% of total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total Billed Charges,12.8,80,,10.24,percent of total Billed Charges,80% of Total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total Billed Charges,9.92,13.6,
Medical/surgical sterile supply,72230,CDM,272,RC,,,Outpatient,,,18.5,12.95,,14.8,80,,11.84,percent of total Billed Charges,80% of Total Billed Charges,11.66,63,,9.328,percent of total Billed charges,63% of Total Billed Charges,11.47,62,,9.176,percent of total Billed Charges,62% of total BIlled charges,11.66,63,,9.328,percent of total Billed Charges,63% of total Billed Charges,15.73,85,,12.584,percent of total Billed Charges,85% of total Billed Charges,14.8,80,,11.84,percent of total Billed Charges,80% of total Billed Charges,11.47,62,,9.176,percent of total Billed Charges,62% of total Billed Charges,11.66,63,,9.328,percent of total Billed Charges,63% of total Billed Charges,11.47,62,,9.176,percent of total Billed Charges,62% of total Billed Charges,11.66,63,,9.328,percent of total billed charges,63% of total Billed Charges,11.47,62,,9.176,percent of total Billed Charges,62% of total Billed Charges,14.8,80,,11.84,percent of total Billed Charges,80% of Total Billed Charges,11.47,62,,9.176,percent of total Billed Charges,62% of total Billed Charges,11.47,62,,9.176,percent of total Billed Charges,62% of total Billed Charges,11.47,15.73,
Medical/surgical sterile supply,72357,CDM,272,RC,,,Outpatient,,,5.81,4.067,,4.65,80,,3.72,percent of total Billed Charges,80% of Total Billed Charges,3.66,63,,2.928,percent of total Billed charges,63% of Total Billed Charges,3.6,62,,2.88,percent of total Billed Charges,62% of total BIlled charges,3.66,63,,2.928,percent of total Billed Charges,63% of total Billed Charges,4.94,85,,3.952,percent of total Billed Charges,85% of total Billed Charges,4.65,80,,3.72,percent of total Billed Charges,80% of total Billed Charges,3.6,62,,2.88,percent of total Billed Charges,62% of total Billed Charges,3.66,63,,2.928,percent of total Billed Charges,63% of total Billed Charges,3.6,62,,2.88,percent of total Billed Charges,62% of total Billed Charges,3.66,63,,2.928,percent of total billed charges,63% of total Billed Charges,3.6,62,,2.88,percent of total Billed Charges,62% of total Billed Charges,4.65,80,,3.72,percent of total Billed Charges,80% of Total Billed Charges,3.6,62,,2.88,percent of total Billed Charges,62% of total Billed Charges,3.6,62,,2.88,percent of total Billed Charges,62% of total Billed Charges,3.6,4.94,
Medical/surgical sterile supply,71595,CDM,272,RC,,,Outpatient,,,219.75,153.825,,175.8,80,,140.64,percent of total Billed Charges,80% of Total Billed Charges,138.44,63,,110.752,percent of total Billed charges,63% of Total Billed Charges,136.25,62,,109,percent of total Billed Charges,62% of total BIlled charges,138.44,63,,110.752,percent of total Billed Charges,63% of total Billed Charges,186.79,85,,149.432,percent of total Billed Charges,85% of total Billed Charges,175.8,80,,140.64,percent of total Billed Charges,80% of total Billed Charges,136.25,62,,109,percent of total Billed Charges,62% of total Billed Charges,138.44,63,,110.752,percent of total Billed Charges,63% of total Billed Charges,136.25,62,,109,percent of total Billed Charges,62% of total Billed Charges,138.44,63,,110.752,percent of total billed charges,63% of total Billed Charges,136.25,62,,109,percent of total Billed Charges,62% of total Billed Charges,175.8,80,,140.64,percent of total Billed Charges,80% of Total Billed Charges,136.25,62,,109,percent of total Billed Charges,62% of total Billed Charges,136.25,62,,109,percent of total Billed Charges,62% of total Billed Charges,136.25,186.79,
Medical/surgical sterile supply,72090,CDM,272,RC,,,Outpatient,,,2892.5,2024.75,,2314,80,,1851.2,percent of total Billed Charges,80% of Total Billed Charges,1822.28,63,,1457.824,percent of total Billed charges,63% of Total Billed Charges,1793.35,62,,1434.68,percent of total Billed Charges,62% of total BIlled charges,1822.28,63,,1457.824,percent of total Billed Charges,63% of total Billed Charges,2458.63,85,,1966.904,percent of total Billed Charges,85% of total Billed Charges,2314,80,,1851.2,percent of total Billed Charges,80% of total Billed Charges,1793.35,62,,1434.68,percent of total Billed Charges,62% of total Billed Charges,1822.28,63,,1457.824,percent of total Billed Charges,63% of total Billed Charges,1793.35,62,,1434.68,percent of total Billed Charges,62% of total Billed Charges,1822.28,63,,1457.824,percent of total billed charges,63% of total Billed Charges,1793.35,62,,1434.68,percent of total Billed Charges,62% of total Billed Charges,2314,80,,1851.2,percent of total Billed Charges,80% of Total Billed Charges,1793.35,62,,1434.68,percent of total Billed Charges,62% of total Billed Charges,1793.35,62,,1434.68,percent of total Billed Charges,62% of total Billed Charges,1793.35,2458.63,
Medical/surgical sterile supply,72045,CDM,272,RC,,,Outpatient,,,48.5,33.95,,38.8,80,,31.04,percent of total Billed Charges,80% of Total Billed Charges,30.56,63,,24.448,percent of total Billed charges,63% of Total Billed Charges,30.07,62,,24.056,percent of total Billed Charges,62% of total BIlled charges,30.56,63,,24.448,percent of total Billed Charges,63% of total Billed Charges,41.23,85,,32.984,percent of total Billed Charges,85% of total Billed Charges,38.8,80,,31.04,percent of total Billed Charges,80% of total Billed Charges,30.07,62,,24.056,percent of total Billed Charges,62% of total Billed Charges,30.56,63,,24.448,percent of total Billed Charges,63% of total Billed Charges,30.07,62,,24.056,percent of total Billed Charges,62% of total Billed Charges,30.56,63,,24.448,percent of total billed charges,63% of total Billed Charges,30.07,62,,24.056,percent of total Billed Charges,62% of total Billed Charges,38.8,80,,31.04,percent of total Billed Charges,80% of Total Billed Charges,30.07,62,,24.056,percent of total Billed Charges,62% of total Billed Charges,30.07,62,,24.056,percent of total Billed Charges,62% of total Billed Charges,30.07,41.23,
Medical/surgical sterile supply,70047,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70046,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,71038,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,71037,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72227,CDM,272,RC,,,Outpatient,,,147.5,103.25,,118,80,,94.4,percent of total Billed Charges,80% of Total Billed Charges,92.93,63,,74.344,percent of total Billed charges,63% of Total Billed Charges,91.45,62,,73.16,percent of total Billed Charges,62% of total BIlled charges,92.93,63,,74.344,percent of total Billed Charges,63% of total Billed Charges,125.38,85,,100.304,percent of total Billed Charges,85% of total Billed Charges,118,80,,94.4,percent of total Billed Charges,80% of total Billed Charges,91.45,62,,73.16,percent of total Billed Charges,62% of total Billed Charges,92.93,63,,74.344,percent of total Billed Charges,63% of total Billed Charges,91.45,62,,73.16,percent of total Billed Charges,62% of total Billed Charges,92.93,63,,74.344,percent of total billed charges,63% of total Billed Charges,91.45,62,,73.16,percent of total Billed Charges,62% of total Billed Charges,118,80,,94.4,percent of total Billed Charges,80% of Total Billed Charges,91.45,62,,73.16,percent of total Billed Charges,62% of total Billed Charges,91.45,62,,73.16,percent of total Billed Charges,62% of total Billed Charges,91.45,125.38,
Medical/surgical sterile supply,50155,CDM,272,RC,,,Outpatient,,,7,4.9,,5.6,80,,4.48,percent of total Billed Charges,80% of Total Billed Charges,4.41,63,,3.528,percent of total Billed charges,63% of Total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total BIlled charges,4.41,63,,3.528,percent of total Billed Charges,63% of total Billed Charges,5.95,85,,4.76,percent of total Billed Charges,85% of total Billed Charges,5.6,80,,4.48,percent of total Billed Charges,80% of total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,4.41,63,,3.528,percent of total Billed Charges,63% of total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,4.41,63,,3.528,percent of total billed charges,63% of total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,5.6,80,,4.48,percent of total Billed Charges,80% of Total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,4.34,62,,3.472,percent of total Billed Charges,62% of total Billed Charges,4.34,5.95,
Medical/surgical sterile supply,71702,CDM,272,RC,,,Outpatient,,,28448.75,19914.125,,22759,80,,18207.2,percent of total Billed Charges,80% of Total Billed Charges,17922.71,63,,14338.168,percent of total Billed charges,63% of Total Billed Charges,17638.23,62,,14110.584,percent of total Billed Charges,62% of total BIlled charges,17922.71,63,,14338.168,percent of total Billed Charges,63% of total Billed Charges,24181.44,85,,19345.152,percent of total Billed Charges,85% of total Billed Charges,22759,80,,18207.2,percent of total Billed Charges,80% of total Billed Charges,17638.23,62,,14110.584,percent of total Billed Charges,62% of total Billed Charges,17922.71,63,,14338.168,percent of total Billed Charges,63% of total Billed Charges,17638.23,62,,14110.584,percent of total Billed Charges,62% of total Billed Charges,17922.71,63,,14338.168,percent of total billed charges,63% of total Billed Charges,17638.23,62,,14110.584,percent of total Billed Charges,62% of total Billed Charges,22759,80,,18207.2,percent of total Billed Charges,80% of Total Billed Charges,17638.23,62,,14110.584,percent of total Billed Charges,62% of total Billed Charges,17638.23,62,,14110.584,percent of total Billed Charges,62% of total Billed Charges,17638.23,24181.44,
Medical/surgical sterile supply,71050,CDM,272,RC,,,Outpatient,,,54.25,37.975,,43.4,80,,34.72,percent of total Billed Charges,80% of Total Billed Charges,34.18,63,,27.344,percent of total Billed charges,63% of Total Billed Charges,33.64,62,,26.912,percent of total Billed Charges,62% of total BIlled charges,34.18,63,,27.344,percent of total Billed Charges,63% of total Billed Charges,46.11,85,,36.888,percent of total Billed Charges,85% of total Billed Charges,43.4,80,,34.72,percent of total Billed Charges,80% of total Billed Charges,33.64,62,,26.912,percent of total Billed Charges,62% of total Billed Charges,34.18,63,,27.344,percent of total Billed Charges,63% of total Billed Charges,33.64,62,,26.912,percent of total Billed Charges,62% of total Billed Charges,34.18,63,,27.344,percent of total billed charges,63% of total Billed Charges,33.64,62,,26.912,percent of total Billed Charges,62% of total Billed Charges,43.4,80,,34.72,percent of total Billed Charges,80% of Total Billed Charges,33.64,62,,26.912,percent of total Billed Charges,62% of total Billed Charges,33.64,62,,26.912,percent of total Billed Charges,62% of total Billed Charges,33.64,46.11,
Medical/surgical sterile supply,71845,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72331,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,71039,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,70225,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72082,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72083,CDM,272,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Medical/surgical sterile supply,72002,CDM,272,RC,,,Outpatient,,,123.5,86.45,,98.8,80,,79.04,percent of total Billed Charges,80% of Total Billed Charges,77.81,63,,62.248,percent of total Billed charges,63% of Total Billed Charges,76.57,62,,61.256,percent of total Billed Charges,62% of total BIlled charges,77.81,63,,62.248,percent of total Billed Charges,63% of total Billed Charges,104.98,85,,83.984,percent of total Billed Charges,85% of total Billed Charges,98.8,80,,79.04,percent of total Billed Charges,80% of total Billed Charges,76.57,62,,61.256,percent of total Billed Charges,62% of total Billed Charges,77.81,63,,62.248,percent of total Billed Charges,63% of total Billed Charges,76.57,62,,61.256,percent of total Billed Charges,62% of total Billed Charges,77.81,63,,62.248,percent of total billed charges,63% of total Billed Charges,76.57,62,,61.256,percent of total Billed Charges,62% of total Billed Charges,98.8,80,,79.04,percent of total Billed Charges,80% of Total Billed Charges,76.57,62,,61.256,percent of total Billed Charges,62% of total Billed Charges,76.57,62,,61.256,percent of total Billed Charges,62% of total Billed Charges,76.57,104.98,
Medical/surgical sterile supply,72003,CDM,272,RC,,,Outpatient,,,123.5,86.45,,98.8,80,,79.04,percent of total Billed Charges,80% of Total Billed Charges,77.81,63,,62.248,percent of total Billed charges,63% of Total Billed Charges,76.57,62,,61.256,percent of total Billed Charges,62% of total BIlled charges,77.81,63,,62.248,percent of total Billed Charges,63% of total Billed Charges,104.98,85,,83.984,percent of total Billed Charges,85% of total Billed Charges,98.8,80,,79.04,percent of total Billed Charges,80% of total Billed Charges,76.57,62,,61.256,percent of total Billed Charges,62% of total Billed Charges,77.81,63,,62.248,percent of total Billed Charges,63% of total Billed Charges,76.57,62,,61.256,percent of total Billed Charges,62% of total Billed Charges,77.81,63,,62.248,percent of total billed charges,63% of total Billed Charges,76.57,62,,61.256,percent of total Billed Charges,62% of total Billed Charges,98.8,80,,79.04,percent of total Billed Charges,80% of Total Billed Charges,76.57,62,,61.256,percent of total Billed Charges,62% of total Billed Charges,76.57,62,,61.256,percent of total Billed Charges,62% of total Billed Charges,76.57,104.98,
Medical/surgical sterile supply,72086,CDM,272,RC,,,Outpatient,,,76.9,53.83,,61.52,80,,49.216,percent of total Billed Charges,80% of Total Billed Charges,48.45,63,,38.76,percent of total Billed charges,63% of Total Billed Charges,47.68,62,,38.144,percent of total Billed Charges,62% of total BIlled charges,48.45,63,,38.76,percent of total Billed Charges,63% of total Billed Charges,65.37,85,,52.296,percent of total Billed Charges,85% of total Billed Charges,61.52,80,,49.216,percent of total Billed Charges,80% of total Billed Charges,47.68,62,,38.144,percent of total Billed Charges,62% of total Billed Charges,48.45,63,,38.76,percent of total Billed Charges,63% of total Billed Charges,47.68,62,,38.144,percent of total Billed Charges,62% of total Billed Charges,48.45,63,,38.76,percent of total billed charges,63% of total Billed Charges,47.68,62,,38.144,percent of total Billed Charges,62% of total Billed Charges,61.52,80,,49.216,percent of total Billed Charges,80% of Total Billed Charges,47.68,62,,38.144,percent of total Billed Charges,62% of total Billed Charges,47.68,62,,38.144,percent of total Billed Charges,62% of total Billed Charges,47.68,65.37,
Medical/surgical sterile supply,72085,CDM,272,RC,,,Outpatient,,,76.9,53.83,,61.52,80,,49.216,percent of total Billed Charges,80% of Total Billed Charges,48.45,63,,38.76,percent of total Billed charges,63% of Total Billed Charges,47.68,62,,38.144,percent of total Billed Charges,62% of total BIlled charges,48.45,63,,38.76,percent of total Billed Charges,63% of total Billed Charges,65.37,85,,52.296,percent of total Billed Charges,85% of total Billed Charges,61.52,80,,49.216,percent of total Billed Charges,80% of total Billed Charges,47.68,62,,38.144,percent of total Billed Charges,62% of total Billed Charges,48.45,63,,38.76,percent of total Billed Charges,63% of total Billed Charges,47.68,62,,38.144,percent of total Billed Charges,62% of total Billed Charges,48.45,63,,38.76,percent of total billed charges,63% of total Billed Charges,47.68,62,,38.144,percent of total Billed Charges,62% of total Billed Charges,61.52,80,,49.216,percent of total Billed Charges,80% of Total Billed Charges,47.68,62,,38.144,percent of total Billed Charges,62% of total Billed Charges,47.68,62,,38.144,percent of total Billed Charges,62% of total Billed Charges,47.68,65.37,
80324 LC,141479,CDM,300,RC,80324,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,19.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,19.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,19.94,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,19.55,19.94,
80347 LC,141480,CDM,300,RC,80347,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,23.26,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,23.26,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.26,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,23.73,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,23.26,23.73,
80353 LC,141482,CDM,300,RC,80353,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,12.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,12.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.06,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,12.3,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,12.06,12.3,
80358 LC,141484,CDM,300,RC,80358,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,20.53,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,20.53,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.53,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,20.94,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,20.53,20.94,
80361 LC,141486,CDM,300,RC,80361,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,25.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,25.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.97,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,26.49,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,25.97,26.49,
83521,141464,CDM,300,RC,83521,HCPCS,Outpatient,,,78,54.6,,62.4,80,,49.92,percent of total Billed Charges,80% of Total Billed Charges,13.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.3,85,,53.04,percent of total Billed Charges,85% of total Billed Charges,62.4,80,,49.92,percent of total Billed Charges,80% of total Billed Charges,17.44,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,13.82,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.1,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.4,80,,49.92,percent of total Billed Charges,80% of Total Billed Charges,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.82,66.3,
36600 - COLLECTION: Arterial Draw,141358,CDM,300,RC,36600,HCPCS,Outpatient,,,479,335.3,,383.2,80,,306.56,percent of total Billed Charges,80% of Total Billed Charges,301.77,63,,241.416,percent of total Billed charges,63% of Total Billed Charges,296.98,62,,237.584,percent of total Billed Charges,62% of total BIlled charges,301.77,63,,241.416,percent of total Billed Charges,63% of total Billed Charges,407.15,85,,325.72,percent of total Billed Charges,85% of total Billed Charges,383.2,80,,306.56,percent of total Billed Charges,80% of total Billed Charges,296.98,62,,237.584,percent of total Billed Charges,62% of total Billed Charges,301.77,63,,241.416,percent of total Billed Charges,63% of total Billed Charges,296.98,62,,237.584,percent of total Billed Charges,62% of total Billed Charges,301.77,63,,241.416,percent of total billed charges,63% of total Billed Charges,296.98,62,,237.584,percent of total Billed Charges,62% of total Billed Charges,383.2,80,,306.56,percent of total Billed Charges,80% of Total Billed Charges,296.98,62,,237.584,percent of total Billed Charges,62% of total Billed Charges,296.98,62,,237.584,percent of total Billed Charges,62% of total Billed Charges,296.98,407.15,
86904 - Bill Only Antigen Screening,140330,CDM,300,RC,86904,HCPCS,Outpatient,,,115,80.5,,92,80,,73.6,percent of total Billed Charges,80% of Total Billed Charges,11.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.34,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,97.75,85,,78.2,percent of total Billed Charges,85% of total Billed Charges,92,80,,73.6,percent of total Billed Charges,80% of total Billed Charges,16.5,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,11.95,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.34,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.19,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.34,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,92,80,,73.6,percent of total Billed Charges,80% of Total Billed Charges,16.34,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.34,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.95,97.75,
.Amphetamine GC/MS Ur 737683 LC,141479,CDM,300,RC,80324,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,19.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,19.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,19.94,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,19.55,19.94,
.Cocaine GCMS 737762 LC,141482,CDM,300,RC,80353,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,12.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,12.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.06,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,12.3,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,12.06,12.3,
86696 - .HSV-2 IgG Supplemental 163006 LC,140816,CDM,300,RC,86696,HCPCS,Outpatient,,,120,84,,96,80,,76.8,percent of total Billed Charges,80% of Total Billed Charges,24.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,19.35,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,102,85,,81.6,percent of total Billed Charges,85% of total Billed Charges,96,80,,76.8,percent of total Billed Charges,80% of total Billed Charges,19.54,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,24.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,19.35,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.84,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,19.35,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,96,80,,76.8,percent of total Billed Charges,80% of Total Billed Charges,19.35,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.35,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.35,102,
.Meper/Normep GCMS Ur 761050 LC,141498,CDM,300,RC,80362,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,24.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,24.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,24.47,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,24.96,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,24.47,24.96,
".Methadone Conf, MS, Ur LC",141484,CDM,300,RC,80358,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,20.53,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,20.53,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,20.53,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,20.94,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,20.53,20.94,
".Phencyclidine Conf, MS, Ur LC",141496,CDM,300,RC,83992,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,18.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,18.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,18.86,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,18.49,18.86,
"17-Ketosteroids, Urine LC",141499,CDM,300,RC,83586,HCPCS,Outpatient,,,58,40.6,,46.4,80,,37.12,percent of total Billed Charges,80% of Total Billed Charges,15.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,49.3,85,,39.44,percent of total Billed Charges,85% of total Billed Charges,46.4,80,,37.12,percent of total Billed Charges,80% of total Billed Charges,12.93,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.8,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.12,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,46.4,80,,37.12,percent of total Billed Charges,80% of Total Billed Charges,12.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.8,49.3,
763824 12+Oxy+Crt-Unbund LC,141447,CDM,300,RC,80307,HCPCS,Outpatient,,,396,277.2,,316.8,80,,253.44,percent of total Billed Charges,80% of Total Billed Charges,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,336.6,85,,269.28,percent of total Billed Charges,85% of total Billed Charges,316.8,80,,253.44,percent of total Billed Charges,80% of total Billed Charges,62.76,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,316.8,80,,253.44,percent of total Billed Charges,80% of Total Billed Charges,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.16,336.6,
Barbiturate GCMS Ur 737697 LC,141475,CDM,300,RC,80345,HCPCS,Outpatient,,,515,360.5,,412,80,,329.6,percent of total Billed Charges,80% of Total Billed Charges,14.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,319.3,62,,255.44,percent of total Billed Charges,62% of total BIlled charges,14.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,437.75,85,,350.2,percent of total Billed Charges,85% of total Billed Charges,412,80,,329.6,percent of total Billed Charges,80% of total Billed Charges,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,14.41,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,14.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,412,80,,329.6,percent of total Billed Charges,80% of Total Billed Charges,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,14.41,437.75,
Benzodiazepines Conf Ur 763910 LC,141476,CDM,300,RC,80346,HCPCS,Outpatient,,,515,360.5,,412,80,,329.6,percent of total Billed Charges,80% of Total Billed Charges,23.26,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,319.3,62,,255.44,percent of total Billed Charges,62% of total BIlled charges,23.26,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,437.75,85,,350.2,percent of total Billed Charges,85% of total Billed Charges,412,80,,329.6,percent of total Billed Charges,80% of total Billed Charges,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,23.26,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,23.73,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,412,80,,329.6,percent of total Billed Charges,80% of Total Billed Charges,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,23.26,437.75,
99999 - Bill Only Chain of Custody Drug Screens,140525,CDM,300,RC,99999,HCPCS,Outpatient,,,15,10.5,,12,80,,9.6,percent of total Billed Charges,80% of Total Billed Charges,9.45,63,,7.56,percent of total Billed charges,63% of Total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total BIlled charges,9.45,63,,7.56,percent of total Billed Charges,63% of total Billed Charges,12.75,85,,10.2,percent of total Billed Charges,85% of total Billed Charges,12,80,,9.6,percent of total Billed Charges,80% of total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total Billed Charges,9.45,63,,7.56,percent of total Billed Charges,63% of total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total Billed Charges,9.45,63,,7.56,percent of total billed charges,63% of total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total Billed Charges,12,80,,9.6,percent of total Billed Charges,80% of Total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total Billed Charges,9.3,62,,7.44,percent of total Billed Charges,62% of total Billed Charges,9.3,12.75,
99999 - Bill OnlyDrug Screen Collection Non-DOT,140836,CDM,300,RC,99999,HCPCS,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,56.7,63,,45.36,percent of total Billed charges,63% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total BIlled charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total billed charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,76.5,
36415 - Bill Only Venipuncture,140050,CDM,300,RC,36415,HCPCS,Outpatient,,,14,9.8,,11.2,80,,8.96,percent of total Billed Charges,80% of Total Billed Charges,8.82,63,,7.056,percent of total Billed charges,63% of Total Billed Charges,8.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.82,63,,7.056,percent of total Billed Charges,63% of total Billed Charges,11.9,85,,9.52,percent of total Billed Charges,85% of total Billed Charges,11.2,80,,8.96,percent of total Billed Charges,80% of total Billed Charges,8.92,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.82,63,,7.056,percent of total Billed Charges,63% of total Billed Charges,8.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.82,63,,7.056,percent of total billed charges,63% of total Billed Charges,8.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.2,80,,8.96,percent of total Billed Charges,80% of Total Billed Charges,8.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.82,11.9,
99999 - Bill Only Venipuncture LC,140983,CDM,300,RC,99999,HCPCS,Outpatient,,,8.5,5.95,,6.8,80,,5.44,percent of total Billed Charges,80% of Total Billed Charges,5.36,63,,4.288,percent of total Billed charges,63% of Total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total BIlled charges,5.36,63,,4.288,percent of total Billed Charges,63% of total Billed Charges,7.23,85,,5.784,percent of total Billed Charges,85% of total Billed Charges,6.8,80,,5.44,percent of total Billed Charges,80% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.36,63,,4.288,percent of total Billed Charges,63% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.36,63,,4.288,percent of total billed charges,63% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,6.8,80,,5.44,percent of total Billed Charges,80% of Total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.27,62,,4.216,percent of total Billed Charges,62% of total Billed Charges,5.27,7.23,
Bill only Capillary Collection,136416,CDM,300,RC,36416,HCPCS,Outpatient,,,14,9.8,,11.2,80,,8.96,percent of total Billed Charges,80% of Total Billed Charges,8.82,63,,7.056,percent of total Billed charges,63% of Total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total BIlled charges,8.82,63,,7.056,percent of total Billed Charges,63% of total Billed Charges,11.9,85,,9.52,percent of total Billed Charges,85% of total Billed Charges,11.2,80,,8.96,percent of total Billed Charges,80% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.82,63,,7.056,percent of total Billed Charges,63% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.82,63,,7.056,percent of total billed charges,63% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,11.2,80,,8.96,percent of total Billed Charges,80% of Total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.68,11.9,
140818 - C-reactive Protein Cardiac LC,86141,CDM,300,RC,86141,HCPCS,Outpatient,,,72,50.4,,57.6,80,,46.08,percent of total Billed Charges,80% of Total Billed Charges,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.2,85,,48.96,percent of total Billed Charges,85% of total Billed Charges,57.6,80,,46.08,percent of total Billed Charges,80% of total Billed Charges,13.08,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,16.28,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.61,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,57.6,80,,46.08,percent of total Billed Charges,80% of Total Billed Charges,12.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.95,61.2,
36600 - COLLECTION: Arterial Draw,141358,CDM,300,RC,36600,HCPCS,Outpatient,,,479,335.3,,383.2,80,,306.56,percent of total Billed Charges,80% of Total Billed Charges,301.77,63,,241.416,percent of total Billed charges,63% of Total Billed Charges,296.98,62,,237.584,percent of total Billed Charges,62% of total BIlled charges,301.77,63,,241.416,percent of total Billed Charges,63% of total Billed Charges,407.15,85,,325.72,percent of total Billed Charges,85% of total Billed Charges,383.2,80,,306.56,percent of total Billed Charges,80% of total Billed Charges,296.98,62,,237.584,percent of total Billed Charges,62% of total Billed Charges,301.77,63,,241.416,percent of total Billed Charges,63% of total Billed Charges,296.98,62,,237.584,percent of total Billed Charges,62% of total Billed Charges,301.77,63,,241.416,percent of total billed charges,63% of total Billed Charges,296.98,62,,237.584,percent of total Billed Charges,62% of total Billed Charges,383.2,80,,306.56,percent of total Billed Charges,80% of Total Billed Charges,296.98,62,,237.584,percent of total Billed Charges,62% of total Billed Charges,296.98,62,,237.584,percent of total Billed Charges,62% of total Billed Charges,296.98,407.15,
36416 - COLLECTION: Capillary,141167,CDM,300,RC,36416,HCPCS,Outpatient,,,14,9.8,,11.2,80,,8.96,percent of total Billed Charges,80% of Total Billed Charges,8.82,63,,7.056,percent of total Billed charges,63% of Total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total BIlled charges,8.82,63,,7.056,percent of total Billed Charges,63% of total Billed Charges,11.9,85,,9.52,percent of total Billed Charges,85% of total Billed Charges,11.2,80,,8.96,percent of total Billed Charges,80% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.82,63,,7.056,percent of total Billed Charges,63% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.82,63,,7.056,percent of total billed charges,63% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,11.2,80,,8.96,percent of total Billed Charges,80% of Total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.68,62,,6.944,percent of total Billed Charges,62% of total Billed Charges,8.68,11.9,
36415 - COLLECTION: Venous Draw,140050,CDM,300,RC,36415,HCPCS,Outpatient,,,14,9.8,,11.2,80,,8.96,percent of total Billed Charges,80% of Total Billed Charges,8.82,63,,7.056,percent of total Billed charges,63% of Total Billed Charges,8.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.82,63,,7.056,percent of total Billed Charges,63% of total Billed Charges,11.9,85,,9.52,percent of total Billed Charges,85% of total Billed Charges,11.2,80,,8.96,percent of total Billed Charges,80% of total Billed Charges,8.92,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.82,63,,7.056,percent of total Billed Charges,63% of total Billed Charges,8.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.82,63,,7.056,percent of total billed charges,63% of total Billed Charges,8.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.2,80,,8.96,percent of total Billed Charges,80% of Total Billed Charges,8.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.82,11.9,
82300 - Cadmium Blood LC,140752,CDM,300,RC,82300,HCPCS,Outpatient,,,129,90.3,,103.2,80,,82.56,percent of total Billed Charges,80% of Total Billed Charges,29.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.64,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,29.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,109.65,85,,87.72,percent of total Billed Charges,85% of total Billed Charges,103.2,80,,82.56,percent of total Billed Charges,80% of total Billed Charges,23.88,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,29.1,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,23.64,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,29.68,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,23.64,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,103.2,80,,82.56,percent of total Billed Charges,80% of Total Billed Charges,23.64,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.64,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.64,109.65,
82465 - Cholesterol Total,140951,CDM,300,RC,82465,HCPCS,Outpatient,,,24,16.8,,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,5.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.35,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.4,85,,16.32,percent of total Billed Charges,85% of total Billed Charges,19.2,80,,15.36,percent of total Billed Charges,80% of total Billed Charges,4.39,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,5.47,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,4.35,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.58,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,4.35,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,4.35,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.35,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.35,20.4,
82495 - Chromium LC,141463,CDM,300,RC,82495,HCPCS,Outpatient,,,92,64.4,,73.6,80,,58.88,percent of total Billed Charges,80% of Total Billed Charges,25.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,78.2,85,,62.56,percent of total Billed Charges,85% of total Billed Charges,73.6,80,,58.88,percent of total Billed Charges,80% of total Billed Charges,20.48,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,25.51,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,20.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.02,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,20.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,73.6,80,,58.88,percent of total Billed Charges,80% of Total Billed Charges,20.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.28,78.2,
"Drug Profile, Ur, 9 Drugs LC",141447,CDM,300,RC,80307,HCPCS,Outpatient,,,396,277.2,,316.8,80,,253.44,percent of total Billed Charges,80% of Total Billed Charges,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,336.6,85,,269.28,percent of total Billed Charges,85% of total Billed Charges,316.8,80,,253.44,percent of total Billed Charges,80% of total Billed Charges,62.76,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,316.8,80,,253.44,percent of total Billed Charges,80% of Total Billed Charges,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.16,336.6,
80307 - Drug Screen Urine,141172,CDM,300,RC,80307,HCPCS,Outpatient,,,323,226.1,,258.4,80,,206.72,percent of total Billed Charges,80% of Total Billed Charges,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,274.55,85,,219.64,percent of total Billed Charges,85% of total Billed Charges,258.4,80,,206.72,percent of total Billed Charges,80% of total Billed Charges,62.76,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,258.4,80,,206.72,percent of total Billed Charges,80% of Total Billed Charges,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.16,274.55,
"Antibody; Epstein-Barr (EB) virus, viral capsid (VCA)",140857,CDM,300,RC,86665,HCPCS,Outpatient,,,82,57.4,,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,22.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,69.7,85,,55.76,percent of total Billed Charges,85% of total Billed Charges,65.6,80,,52.48,percent of total Billed Charges,80% of total Billed Charges,18.32,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.82,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,18.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.28,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,18.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,18.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.14,69.7,
"Antibody; Epstein-Barr (EB) virus, viral capsid (VCA)",140857,CDM,300,RC,86665,HCPCS,Outpatient,,,82,57.4,,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,22.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,69.7,85,,55.76,percent of total Billed Charges,85% of total Billed Charges,65.6,80,,52.48,percent of total Billed Charges,80% of total Billed Charges,18.32,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.82,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,18.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.28,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,18.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,18.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.14,69.7,
"Ethanol, Urine w/ Confirmation 735316 LC",141447,CDM,300,RC,80307,HCPCS,Outpatient,,,396,277.2,,316.8,80,,253.44,percent of total Billed Charges,80% of Total Billed Charges,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,336.6,85,,269.28,percent of total Billed Charges,85% of total Billed Charges,316.8,80,,253.44,percent of total Billed Charges,80% of total Billed Charges,62.76,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,316.8,80,,253.44,percent of total Billed Charges,80% of Total Billed Charges,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.16,336.6,
83521 - Fr Kappa Lt Chains LC,141464,CDM,300,RC,83521,HCPCS,Outpatient,,,78,54.6,,62.4,80,,49.92,percent of total Billed Charges,80% of Total Billed Charges,13.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.3,85,,53.04,percent of total Billed Charges,85% of total Billed Charges,62.4,80,,49.92,percent of total Billed Charges,80% of total Billed Charges,17.44,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,13.82,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.1,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.4,80,,49.92,percent of total Billed Charges,80% of Total Billed Charges,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.82,66.3,
83521 - Fr Lambda Lt Chains LC,141464,CDM,300,RC,83521,HCPCS,Outpatient,,,78,54.6,,62.4,80,,49.92,percent of total Billed Charges,80% of Total Billed Charges,13.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.3,85,,53.04,percent of total Billed Charges,85% of total Billed Charges,62.4,80,,49.92,percent of total Billed Charges,80% of total Billed Charges,17.44,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,13.82,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.1,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.4,80,,49.92,percent of total Billed Charges,80% of Total Billed Charges,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.82,66.3,
"Free K+L Lt Chains, Qn, Ur LC",141464,CDM,300,RC,83521,HCPCS,Outpatient,,,78,54.6,,62.4,80,,49.92,percent of total Billed Charges,80% of Total Billed Charges,13.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,66.3,85,,53.04,percent of total Billed Charges,85% of total Billed Charges,62.4,80,,49.92,percent of total Billed Charges,80% of total Billed Charges,17.44,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,13.82,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.1,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.4,80,,49.92,percent of total Billed Charges,80% of Total Billed Charges,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.82,66.3,
Laboratory services,83305,CDM,300,RC,82962,HCPCS,Outpatient,,,25,17.5,,20,80,,16,percent of total Billed Charges,80% of Total Billed Charges,2.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.25,85,,17,percent of total Billed Charges,85% of total Billed Charges,20,80,,16,percent of total Billed Charges,80% of total Billed Charges,3.31,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,2.94,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,3.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,3.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20,80,,16,percent of total Billed Charges,80% of Total Billed Charges,3.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.94,21.25,
81374 - HLA B 27 Disease Association LC,141467,CDM,300,RC,81374,HCPCS,Outpatient,,,335,234.5,,268,80,,214.4,percent of total Billed Charges,80% of Total Billed Charges,98.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,74.33,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,98.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,284.75,85,,227.8,percent of total Billed Charges,85% of total Billed Charges,268,80,,214.4,percent of total Billed Charges,80% of total Billed Charges,75.07,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,98.4,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,74.33,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,100.37,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,74.33,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,268,80,,214.4,percent of total Billed Charges,80% of Total Billed Charges,74.33,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,74.33,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,74.33,284.75,
86695 - HSV 1 IgG Type Spec LC,140815,CDM,300,RC,86695,HCPCS,Outpatient,,,82,57.4,,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,16.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.19,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,69.7,85,,55.76,percent of total Billed Charges,85% of total Billed Charges,65.6,80,,52.48,percent of total Billed Charges,80% of total Billed Charges,13.32,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,16.59,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.19,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.92,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.19,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,13.19,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.19,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.19,69.7,
86696 - HSV 2 IgG Type Spec LC,140816,CDM,300,RC,86696,HCPCS,Outpatient,,,120,84,,96,80,,76.8,percent of total Billed Charges,80% of Total Billed Charges,24.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,19.35,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,102,85,,81.6,percent of total Billed Charges,85% of total Billed Charges,96,80,,76.8,percent of total Billed Charges,80% of total Billed Charges,19.54,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,24.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,19.35,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.84,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,19.35,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,96,80,,76.8,percent of total Billed Charges,80% of Total Billed Charges,19.35,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.35,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.35,102,
Laboratory services,83306,CDM,300,RC,85018,HCPCS,Outpatient,,,15,10.5,,12,80,,9.6,percent of total Billed Charges,80% of Total Billed Charges,2.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,2.37,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.75,85,,10.2,percent of total Billed Charges,85% of total Billed Charges,12,80,,9.6,percent of total Billed Charges,80% of total Billed Charges,2.39,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,2.98,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,2.37,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.04,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,2.37,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12,80,,9.6,percent of total Billed Charges,80% of Total Billed Charges,2.37,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.37,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.37,12.75,
Laboratory services,84194,CDM,300,RC,87804,HCPCS,Outpatient,,,25,17.5,,20,80,,16,percent of total Billed Charges,80% of Total Billed Charges,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.25,85,,17,percent of total Billed Charges,85% of total Billed Charges,20,80,,16,percent of total Billed Charges,80% of total Billed Charges,16.72,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20,80,,16,percent of total Billed Charges,80% of Total Billed Charges,16.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,21.25,
Monitor Drug Profile 14(MW) LC,141447,CDM,300,RC,80307,HCPCS,Outpatient,,,396,277.2,,316.8,80,,253.44,percent of total Billed Charges,80% of Total Billed Charges,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,336.6,85,,269.28,percent of total Billed Charges,85% of total Billed Charges,316.8,80,,253.44,percent of total Billed Charges,80% of total Billed Charges,62.76,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,316.8,80,,253.44,percent of total Billed Charges,80% of Total Billed Charges,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.16,336.6,
"Opiates Confirmation, Urine LC",141486,CDM,300,RC,80361,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,25.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,25.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.97,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,26.49,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,25.97,26.49,
87807 - RSV,140755,CDM,300,RC,87807,HCPCS,Outpatient,,,67,46.9,,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.95,85,,45.56,percent of total Billed Charges,85% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of total Billed Charges,13.23,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,13.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.1,56.95,
Laboratory services,140755,CDM,300,RC,87807,HCPCS,Outpatient,,,67,46.9,,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.95,85,,45.56,percent of total Billed Charges,85% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of total Billed Charges,13.23,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,13.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.1,56.95,
84295 - Sodium Level,140193,CDM,300,RC,84295,HCPCS,Outpatient,,,27,18.9,,21.6,80,,17.28,percent of total Billed Charges,80% of Total Billed Charges,6.05,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.05,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.95,85,,18.36,percent of total Billed Charges,85% of total Billed Charges,21.6,80,,17.28,percent of total Billed Charges,80% of total Billed Charges,4.86,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.05,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,4.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.17,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,4.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.6,80,,17.28,percent of total Billed Charges,80% of Total Billed Charges,4.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.81,22.95,
ToxASSURE Select 13 (MW) (LC),141215,CDM,300,RC,80307,HCPCS,Outpatient,,,323,226.1,,258.4,80,,206.72,percent of total Billed Charges,80% of Total Billed Charges,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,274.55,85,,219.64,percent of total Billed Charges,85% of total Billed Charges,258.4,80,,206.72,percent of total Billed Charges,80% of total Billed Charges,62.76,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,258.4,80,,206.72,percent of total Billed Charges,80% of Total Billed Charges,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.16,274.55,
141357 - Toxo gondii Ab IgG LC,86777,CDM,300,RC,86777,HCPCS,Outpatient,,,72,50.4,,57.6,80,,46.08,percent of total Billed Charges,80% of Total Billed Charges,14.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.2,85,,48.96,percent of total Billed Charges,85% of total Billed Charges,57.6,80,,46.08,percent of total Billed Charges,80% of total Billed Charges,14.53,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,14.63,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.92,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,57.6,80,,46.08,percent of total Billed Charges,80% of Total Billed Charges,14.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.39,61.2,
Laboratory services,83301,CDM,300,RC,81002,HCPCS,Outpatient,,,16,11.2,,12.8,80,,10.24,percent of total Billed Charges,80% of Total Billed Charges,3.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.48,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.6,85,,10.88,percent of total Billed Charges,85% of total Billed Charges,12.8,80,,10.24,percent of total Billed Charges,80% of total Billed Charges,3.51,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,3.21,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,3.48,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.27,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,3.48,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.8,80,,10.24,percent of total Billed Charges,80% of Total Billed Charges,3.48,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.48,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.21,13.6,
Laboratory services,83303,CDM,300,RC,81025,HCPCS,Outpatient,,,13,9.1,,10.4,80,,8.32,percent of total Billed Charges,80% of Total Billed Charges,7.96,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.96,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.05,85,,8.84,percent of total Billed Charges,85% of total Billed Charges,10.4,80,,8.32,percent of total Billed Charges,80% of total Billed Charges,8.7,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,7.96,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.12,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.4,80,,8.32,percent of total Billed Charges,80% of Total Billed Charges,8.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.96,11.05,
140943 - Vitamin B1 (Thiamine) Bld LC,84425,CDM,300,RC,84425,HCPCS,Outpatient,,,118,82.6,,94.4,80,,75.52,percent of total Billed Charges,80% of Total Billed Charges,26.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.23,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,100.3,85,,80.24,percent of total Billed Charges,85% of total Billed Charges,94.4,80,,75.52,percent of total Billed Charges,80% of total Billed Charges,21.44,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,26.7,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,21.23,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,21.23,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,94.4,80,,75.52,percent of total Billed Charges,80% of Total Billed Charges,21.23,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.23,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.23,100.3,
99999 - Environmental Culture,140428,CDM,300,RC,99999,HCPCS,Outpatient,,,16,11.2,,12.8,80,,10.24,percent of total Billed Charges,80% of Total Billed Charges,10.08,63,,8.064,percent of total Billed charges,63% of Total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total BIlled charges,10.08,63,,8.064,percent of total Billed Charges,63% of total Billed Charges,13.6,85,,10.88,percent of total Billed Charges,85% of total Billed Charges,12.8,80,,10.24,percent of total Billed Charges,80% of total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total Billed Charges,10.08,63,,8.064,percent of total Billed Charges,63% of total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total Billed Charges,10.08,63,,8.064,percent of total billed charges,63% of total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total Billed Charges,12.8,80,,10.24,percent of total Billed Charges,80% of Total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total Billed Charges,9.92,62,,7.936,percent of total Billed Charges,62% of total Billed Charges,9.92,13.6,
86580 PPD Administration (TB Screen),83307,CDM,300,RC,86580,HCPCS,Outpatient,,,46,32.2,,36.8,80,,29.44,percent of total Billed Charges,80% of Total Billed Charges,8.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.52,62,,22.816,percent of total Billed Charges,62% of total BIlled charges,8.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.1,85,,31.28,percent of total Billed Charges,85% of total Billed Charges,36.8,80,,29.44,percent of total Billed Charges,80% of total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total Billed Charges,8.13,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,28.52,62,,22.816,percent of total Billed Charges,62% of total Billed Charges,8.29,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,28.52,62,,22.816,percent of total Billed Charges,62% of total Billed Charges,36.8,80,,29.44,percent of total Billed Charges,80% of Total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total Billed Charges,8.13,39.1,
Laboratory services,,,300,RC,86580,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,8.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,8.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.13,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,8.29,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,8.13,8.29,
83021 - .Hgb Fractionation by HPLC LC,183021,CDM,301,RC,83021,HCPCS,Outpatient,,,82,57.4,,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,7.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,69.7,85,,55.76,percent of total Billed Charges,85% of total Billed Charges,65.6,80,,52.48,percent of total Billed Charges,80% of total Billed Charges,18.24,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,7.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,18.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,18.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,18.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.55,69.7,
Immunofixation,140124,CDM,301,RC,82784,HCPCS,Outpatient,,,52,36.4,,41.6,80,,33.28,percent of total Billed Charges,80% of Total Billed Charges,11.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,44.2,85,,35.36,percent of total Billed Charges,85% of total Billed Charges,41.6,80,,33.28,percent of total Billed Charges,80% of total Billed Charges,9.39,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,11.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,9.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.92,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,9.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,41.6,80,,33.28,percent of total Billed Charges,80% of Total Billed Charges,9.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.3,44.2,
".Ethanol Confirm, Urine LC",140008,CDM,301,RC,80320,HCPCS,Outpatient,,,515,360.5,,412,80,,329.6,percent of total Billed Charges,80% of Total Billed Charges,13.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,319.3,62,,255.44,percent of total Billed Charges,62% of total BIlled charges,13.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,437.75,85,,350.2,percent of total Billed Charges,85% of total Billed Charges,412,80,,329.6,percent of total Billed Charges,80% of total Billed Charges,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,13.59,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,13.86,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,412,80,,329.6,percent of total Billed Charges,80% of Total Billed Charges,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,13.59,437.75,
.Hgb Fractionation by HPLC LC,183021,CDM,301,RC,83021,HCPCS,Outpatient,,,82,57.4,,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,7.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,69.7,85,,55.76,percent of total Billed Charges,85% of total Billed Charges,65.6,80,,52.48,percent of total Billed Charges,80% of total Billed Charges,18.24,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,7.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,18.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,18.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,18.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.55,69.7,
141027 - 17-OH Progesterone LC/MS LC,83498,CDM,301,RC,83498,HCPCS,Outpatient,,,151,105.7,,120.8,80,,96.64,percent of total Billed Charges,80% of Total Billed Charges,34.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,34.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,128.35,85,,102.68,percent of total Billed Charges,85% of total Billed Charges,120.8,80,,96.64,percent of total Billed Charges,80% of total Billed Charges,27.44,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,34.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,27.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,34.84,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,27.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,120.8,80,,96.64,percent of total Billed Charges,80% of Total Billed Charges,27.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.17,128.35,
82306 - 25-Hydroxyvitamin D LCMS D2+D3 LC,140619,CDM,301,RC,82306,HCPCS,Outpatient,,,165,115.5,,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,37.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,37.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,140.25,85,,112.2,percent of total Billed Charges,85% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of total Billed Charges,29.9,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,37.22,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,29.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,37.96,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,29.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,29.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,29.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,29.6,140.25,
82103 - A-1-Antitrypsin LC,140014,CDM,301,RC,82103,HCPCS,Outpatient,,,75,52.5,,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,16.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.44,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,63.75,85,,51,percent of total Billed Charges,85% of total Billed Charges,60,80,,48,percent of total Billed Charges,80% of total Billed Charges,13.57,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,16.89,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.44,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.44,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,13.44,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.44,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.44,63.75,
ACTH LC,140004,CDM,301,RC,82024,HCPCS,Outpatient,,,215,150.5,,172,80,,137.6,percent of total Billed Charges,80% of Total Billed Charges,48.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,38.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,48.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,182.75,85,,146.2,percent of total Billed Charges,85% of total Billed Charges,172,80,,137.6,percent of total Billed Charges,80% of total Billed Charges,39.01,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,48.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,38.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,49.54,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,38.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,172,80,,137.6,percent of total Billed Charges,80% of Total Billed Charges,38.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,38.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,38.62,182.75,
140643 - ADH LC,84588,CDM,301,RC,84588,HCPCS,Outpatient,,,210,147,,168,80,,134.4,percent of total Billed Charges,80% of Total Billed Charges,42.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,33.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,178.5,85,,142.8,percent of total Billed Charges,85% of total Billed Charges,168,80,,134.4,percent of total Billed Charges,80% of total Billed Charges,34.28,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,42.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,33.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,43.54,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,33.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,168,80,,134.4,percent of total Billed Charges,80% of Total Billed Charges,33.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,33.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,33.94,178.5,
140686 - AFP Tumor Marker LC,82105,CDM,301,RC,82105,HCPCS,Outpatient,,,93,65.1,,74.4,80,,59.52,percent of total Billed Charges,80% of Total Billed Charges,21.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,79.05,85,,63.24,percent of total Billed Charges,85% of total Billed Charges,74.4,80,,59.52,percent of total Billed Charges,80% of total Billed Charges,16.94,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,21.1,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.52,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,74.4,80,,59.52,percent of total Billed Charges,80% of Total Billed Charges,16.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.77,79.05,
80329 - Acetaminophen Level,140190,CDM,301,RC,80329,HCPCS,Outpatient,,,323,226.1,,258.4,80,,206.72,percent of total Billed Charges,80% of Total Billed Charges,25.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,200.26,62,,160.208,percent of total Billed Charges,62% of total BIlled charges,25.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,274.55,85,,219.64,percent of total Billed Charges,85% of total Billed Charges,258.4,80,,206.72,percent of total Billed Charges,80% of total Billed Charges,200.26,62,,160.208,percent of total Billed Charges,62% of total Billed Charges,25.45,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,200.26,62,,160.208,percent of total Billed Charges,62% of total Billed Charges,25.96,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,200.26,62,,160.208,percent of total Billed Charges,62% of total Billed Charges,258.4,80,,206.72,percent of total Billed Charges,80% of Total Billed Charges,200.26,62,,160.208,percent of total Billed Charges,62% of total Billed Charges,200.26,62,,160.208,percent of total Billed Charges,62% of total Billed Charges,25.45,274.55,
82009 - Acetone,140002,CDM,301,RC,82009,HCPCS,Outpatient,,,25,17.5,,20,80,,16,percent of total Billed Charges,80% of Total Billed Charges,4.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.25,85,,17,percent of total Billed Charges,85% of total Billed Charges,20,80,,16,percent of total Billed Charges,80% of total Billed Charges,4.57,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.13,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,4.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.21,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,4.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20,80,,16,percent of total Billed Charges,80% of Total Billed Charges,4.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.13,21.25,
84460 - Alanine aminotransferase,140196,CDM,301,RC,84460,HCPCS,Outpatient,,,29,20.3,,23.2,80,,18.56,percent of total Billed Charges,80% of Total Billed Charges,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.65,85,,19.72,percent of total Billed Charges,85% of total Billed Charges,23.2,80,,18.56,percent of total Billed Charges,80% of total Billed Charges,5.35,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.48,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.2,80,,18.56,percent of total Billed Charges,80% of Total Billed Charges,5.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.3,24.65,
82040 - Albumin Level,140007,CDM,301,RC,82040,HCPCS,Outpatient,,,28,19.6,,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,3.62,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.62,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.8,85,,19.04,percent of total Billed Charges,85% of total Billed Charges,22.4,80,,17.92,percent of total Billed Charges,80% of total Billed Charges,5,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,3.62,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,4.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.69,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,4.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,4.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.62,23.8,
82043 - Albumin Random Ur LC,140398,CDM,301,RC,82043,HCPCS,Outpatient,,,28,19.6,,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,7.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.78,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.8,85,,19.04,percent of total Billed Charges,85% of total Billed Charges,22.4,80,,17.92,percent of total Billed Charges,80% of total Billed Charges,5.84,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,7.28,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.78,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.43,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.78,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,5.78,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.78,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.78,23.8,
82043 - Albumin Ur LC,140398,CDM,301,RC,82043,HCPCS,Outpatient,,,28,19.6,,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,7.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.78,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.8,85,,19.04,percent of total Billed Charges,85% of total Billed Charges,22.4,80,,17.92,percent of total Billed Charges,80% of total Billed Charges,5.84,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,7.28,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.78,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.43,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.78,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,5.78,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.78,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.78,23.8,
140009 - Aldolase LC,82085,CDM,301,RC,82085,HCPCS,Outpatient,,,54,37.8,,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.9,85,,36.72,percent of total Billed Charges,85% of total Billed Charges,43.2,80,,34.56,percent of total Billed Charges,80% of total Billed Charges,9.81,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,12.2,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,9.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.44,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,9.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,9.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.71,45.9,
82088 - Aldosterone LC,141340,CDM,301,RC,82088,HCPCS,Outpatient,,,226,158.2,,180.8,80,,144.64,percent of total Billed Charges,80% of Total Billed Charges,51.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,192.1,85,,153.68,percent of total Billed Charges,85% of total Billed Charges,180.8,80,,144.64,percent of total Billed Charges,80% of total Billed Charges,41.16,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,51.25,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,40.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,52.28,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,40.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,180.8,80,,144.64,percent of total Billed Charges,80% of Total Billed Charges,40.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,40.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,40.75,192.1,
82088 - Aldosterone LC/MS LC,141340,CDM,301,RC,82088,HCPCS,Outpatient,,,226,158.2,,180.8,80,,144.64,percent of total Billed Charges,80% of Total Billed Charges,51.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,192.1,85,,153.68,percent of total Billed Charges,85% of total Billed Charges,180.8,80,,144.64,percent of total Billed Charges,80% of total Billed Charges,41.16,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,51.25,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,40.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,52.28,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,40.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,180.8,80,,144.64,percent of total Billed Charges,80% of Total Billed Charges,40.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,40.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,40.75,192.1,
84075 - Alk Phosphatase LC,140013,CDM,301,RC,84075,HCPCS,Outpatient,,,29,20.3,,23.2,80,,18.56,percent of total Billed Charges,80% of Total Billed Charges,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.65,85,,19.72,percent of total Billed Charges,85% of total Billed Charges,23.2,80,,18.56,percent of total Billed Charges,80% of total Billed Charges,5.23,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.48,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.2,80,,18.56,percent of total Billed Charges,80% of Total Billed Charges,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.18,24.65,
84075 - Alkaline Phosphatase,140013,CDM,301,RC,84075,HCPCS,Outpatient,,,29,20.3,,23.2,80,,18.56,percent of total Billed Charges,80% of Total Billed Charges,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.65,85,,19.72,percent of total Billed Charges,85% of total Billed Charges,23.2,80,,18.56,percent of total Billed Charges,80% of total Billed Charges,5.23,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.48,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.2,80,,18.56,percent of total Billed Charges,80% of Total Billed Charges,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.18,24.65,
140014 - Alpha-1-Antitrypsin LC,82103,CDM,301,RC,82103,HCPCS,Outpatient,,,75,52.5,,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,16.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.44,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,63.75,85,,51,percent of total Billed Charges,85% of total Billed Charges,60,80,,48,percent of total Billed Charges,80% of total Billed Charges,13.57,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,16.89,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.44,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.44,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,13.44,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.44,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.44,63.75,
Alpha-1-Glob U LC,140566,CDM,301,RC,84166,HCPCS,Outpatient,,,35,24.5,,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,22.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.75,85,,23.8,percent of total Billed Charges,85% of total Billed Charges,28,80,,22.4,percent of total Billed Charges,80% of total Billed Charges,18.01,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.43,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.88,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,17.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.83,29.75,
84166 - Alpha-1-Glob Ur LC,140566,CDM,301,RC,84166,HCPCS,Outpatient,,,35,24.5,,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,22.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.75,85,,23.8,percent of total Billed Charges,85% of total Billed Charges,28,80,,22.4,percent of total Billed Charges,80% of total Billed Charges,18.01,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.43,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.88,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,17.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.83,29.75,
84165 - Alpha1 Glob LC,140088,CDM,301,RC,84165,HCPCS,Outpatient,,,67,46.9,,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,13.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.95,85,,45.56,percent of total Billed Charges,85% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of total Billed Charges,10.85,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,13.51,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,10.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.78,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,10.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,10.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.74,56.95,
140017 - Ammonia LC,82140,CDM,301,RC,82140,HCPCS,Outpatient,,,81,56.7,,64.8,80,,51.84,percent of total Billed Charges,80% of Total Billed Charges,12.44,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.44,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.85,85,,55.08,percent of total Billed Charges,85% of total Billed Charges,64.8,80,,51.84,percent of total Billed Charges,80% of total Billed Charges,14.72,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,12.44,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.69,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,64.8,80,,51.84,percent of total Billed Charges,80% of Total Billed Charges,14.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.44,68.85,
Ammonia Level,140017,CDM,301,RC,82140,HCPCS,Outpatient,,,81,56.7,,64.8,80,,51.84,percent of total Billed Charges,80% of Total Billed Charges,12.44,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.44,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.85,85,,55.08,percent of total Billed Charges,85% of total Billed Charges,64.8,80,,51.84,percent of total Billed Charges,80% of total Billed Charges,14.72,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,12.44,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.69,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,64.8,80,,51.84,percent of total Billed Charges,80% of Total Billed Charges,14.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.44,68.85,
82150 - Amylase LC,140018,CDM,301,RC,82150,HCPCS,Outpatient,,,36,25.2,,28.8,80,,23.04,percent of total Billed Charges,80% of Total Billed Charges,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.48,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,30.6,85,,24.48,percent of total Billed Charges,85% of total Billed Charges,28.8,80,,23.04,percent of total Billed Charges,80% of total Billed Charges,6.54,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.15,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.48,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.31,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.48,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28.8,80,,23.04,percent of total Billed Charges,80% of Total Billed Charges,6.48,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.48,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.48,30.6,
140189 - Angiotensin-Converting Enzyme LC,82164,CDM,301,RC,82164,HCPCS,Outpatient,,,81,56.7,,64.8,80,,51.84,percent of total Billed Charges,80% of Total Billed Charges,18.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.85,85,,55.08,percent of total Billed Charges,85% of total Billed Charges,64.8,80,,51.84,percent of total Billed Charges,80% of total Billed Charges,14.75,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,18.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.72,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,64.8,80,,51.84,percent of total Billed Charges,80% of Total Billed Charges,14.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.6,68.85,
Anti-GBM Antibodies LC,141304,CDM,301,RC,83516,HCPCS,Outpatient,,,79,55.3,,63.2,80,,50.56,percent of total Billed Charges,80% of Total Billed Charges,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,67.15,85,,53.72,percent of total Billed Charges,85% of total Billed Charges,63.2,80,,50.56,percent of total Billed Charges,80% of total Billed Charges,11.65,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,13.45,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.72,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,63.2,80,,50.56,percent of total Billed Charges,80% of Total Billed Charges,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.53,67.15,
Anti-MPO Antibodies LC,141304,CDM,301,RC,83516,HCPCS,Outpatient,,,79,55.3,,63.2,80,,50.56,percent of total Billed Charges,80% of Total Billed Charges,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,67.15,85,,53.72,percent of total Billed Charges,85% of total Billed Charges,63.2,80,,50.56,percent of total Billed Charges,80% of total Billed Charges,11.65,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,13.45,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.72,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,63.2,80,,50.56,percent of total Billed Charges,80% of Total Billed Charges,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.53,67.15,
Anti-PLA2R LC,141304,CDM,301,RC,83516,HCPCS,Outpatient,,,79,55.3,,63.2,80,,50.56,percent of total Billed Charges,80% of Total Billed Charges,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,67.15,85,,53.72,percent of total Billed Charges,85% of total Billed Charges,63.2,80,,50.56,percent of total Billed Charges,80% of total Billed Charges,11.65,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,13.45,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.72,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,63.2,80,,50.56,percent of total Billed Charges,80% of Total Billed Charges,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.53,67.15,
Anti-PR3 Antibodies LC,141304,CDM,301,RC,83516,HCPCS,Outpatient,,,79,55.3,,63.2,80,,50.56,percent of total Billed Charges,80% of Total Billed Charges,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,67.15,85,,53.72,percent of total Billed Charges,85% of total Billed Charges,63.2,80,,50.56,percent of total Billed Charges,80% of total Billed Charges,11.65,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,13.45,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.72,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,63.2,80,,50.56,percent of total Billed Charges,80% of Total Billed Charges,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.53,67.15,
82175 - Arsenic Blood LC,140719,CDM,301,RC,82175,HCPCS,Outpatient,,,64,44.8,,51.2,80,,40.96,percent of total Billed Charges,80% of Total Billed Charges,23.86,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.97,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.86,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54.4,85,,43.52,percent of total Billed Charges,85% of total Billed Charges,51.2,80,,40.96,percent of total Billed Charges,80% of total Billed Charges,19.16,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,23.86,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,18.97,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.34,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,18.97,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.2,80,,40.96,percent of total Billed Charges,80% of Total Billed Charges,18.97,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.97,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.97,54.4,
82175 - Arsenic Blood LC,140719,CDM,301,RC,82175,HCPCS,Outpatient,,,64,44.8,,51.2,80,,40.96,percent of total Billed Charges,80% of Total Billed Charges,23.86,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.97,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.86,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54.4,85,,43.52,percent of total Billed Charges,85% of total Billed Charges,51.2,80,,40.96,percent of total Billed Charges,80% of total Billed Charges,19.16,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,23.86,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,18.97,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.34,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,18.97,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.2,80,,40.96,percent of total Billed Charges,80% of Total Billed Charges,18.97,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.97,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.97,54.4,
84450 - Aspartate aminotransferase,140195,CDM,301,RC,84450,HCPCS,Outpatient,,,29,20.3,,23.2,80,,18.56,percent of total Billed Charges,80% of Total Billed Charges,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.65,85,,19.72,percent of total Billed Charges,85% of total Billed Charges,23.2,80,,18.56,percent of total Billed Charges,80% of total Billed Charges,5.23,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.48,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.2,80,,18.56,percent of total Billed Charges,80% of Total Billed Charges,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.18,24.65,
83880 - B-Type Natriuretic Peptide,140795,CDM,301,RC,83880,HCPCS,Outpatient,,,189,132.3,,151.2,80,,120.96,percent of total Billed Charges,80% of Total Billed Charges,42.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,160.65,85,,128.52,percent of total Billed Charges,85% of total Billed Charges,151.2,80,,120.96,percent of total Billed Charges,80% of total Billed Charges,39.65,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,42.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,39.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,43.54,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,39.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,151.2,80,,120.96,percent of total Billed Charges,80% of Total Billed Charges,39.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,39.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,39.26,160.65,
80048 - Basic Metabolic Panel,140714,CDM,301,RC,80048,HCPCS,Outpatient,,,47,32.9,,37.6,80,,30.08,percent of total Billed Charges,80% of Total Billed Charges,10.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.46,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.95,85,,31.96,percent of total Billed Charges,85% of total Billed Charges,37.6,80,,30.08,percent of total Billed Charges,80% of total Billed Charges,8.54,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.65,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.46,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.86,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.46,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,37.6,80,,30.08,percent of total Billed Charges,80% of Total Billed Charges,8.46,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.46,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.46,39.95,
84703 - Beta hCG Qualitative Urine,140165,CDM,301,RC,84703,HCPCS,Outpatient,,,42,29.4,,33.6,80,,26.88,percent of total Billed Charges,80% of Total Billed Charges,8.07,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.07,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,35.7,85,,28.56,percent of total Billed Charges,85% of total Billed Charges,33.6,80,,26.88,percent of total Billed Charges,80% of total Billed Charges,7.6,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.07,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,7.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,7.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,33.6,80,,26.88,percent of total Billed Charges,80% of Total Billed Charges,7.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.52,35.7,
84702 - Beta hCG Quantitative,140166,CDM,301,RC,84702,HCPCS,Outpatient,,,84,58.8,,67.2,80,,53.76,percent of total Billed Charges,80% of Total Billed Charges,8.07,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.07,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,71.4,85,,57.12,percent of total Billed Charges,85% of total Billed Charges,67.2,80,,53.76,percent of total Billed Charges,80% of total Billed Charges,15.2,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.07,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,15.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,15.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,67.2,80,,53.76,percent of total Billed Charges,80% of Total Billed Charges,15.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.07,71.4,
141287 - Beta-2 Microglobulin LC,82232,CDM,301,RC,82232,HCPCS,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,20.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,16.34,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,20.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.76,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,16.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.18,76.5,
Beta-Hydroxybutyrate LC,141454,CDM,301,RC,82010,HCPCS,Outpatient,,,37,25.9,,29.6,80,,23.68,percent of total Billed Charges,80% of Total Billed Charges,10.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,31.45,85,,25.16,percent of total Billed Charges,85% of total Billed Charges,29.6,80,,23.68,percent of total Billed Charges,80% of total Billed Charges,8.25,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.28,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.49,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,29.6,80,,23.68,percent of total Billed Charges,80% of Total Billed Charges,8.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.17,31.45,
82248 - Bilirubin Direct,140028,CDM,301,RC,82248,HCPCS,Outpatient,,,28,19.6,,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.8,85,,19.04,percent of total Billed Charges,85% of total Billed Charges,22.4,80,,17.92,percent of total Billed Charges,80% of total Billed Charges,5.07,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.32,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.45,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,5.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.02,23.8,
Bilirubin Direct,140028,CDM,301,RC,82248,HCPCS,Outpatient,,,28,19.6,,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.8,85,,19.04,percent of total Billed Charges,85% of total Billed Charges,22.4,80,,17.92,percent of total Billed Charges,80% of total Billed Charges,5.07,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.32,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.45,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,5.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.02,23.8,
82247 - Bilirubin Total,140027,CDM,301,RC,82247,HCPCS,Outpatient,,,28,19.6,,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.8,85,,19.04,percent of total Billed Charges,85% of total Billed Charges,22.4,80,,17.92,percent of total Billed Charges,80% of total Billed Charges,5.07,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.32,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.45,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,5.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.02,23.8,
Bilirubin Total,140027,CDM,301,RC,82247,HCPCS,Outpatient,,,28,19.6,,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.8,85,,19.04,percent of total Billed Charges,85% of total Billed Charges,22.4,80,,17.92,percent of total Billed Charges,80% of total Billed Charges,5.07,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.32,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.45,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,5.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.02,23.8,
99999 - Bill Only Blood Alcohol,140541,CDM,301,RC,80320,HCPCS,Outpatient,,,67,46.9,,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,13.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,41.54,62,,33.232,percent of total Billed Charges,62% of total BIlled charges,13.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.95,85,,45.56,percent of total Billed Charges,85% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of total Billed Charges,41.54,62,,33.232,percent of total Billed Charges,62% of total Billed Charges,13.59,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,41.54,62,,33.232,percent of total Billed Charges,62% of total Billed Charges,13.86,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,41.54,62,,33.232,percent of total Billed Charges,62% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,41.54,62,,33.232,percent of total Billed Charges,62% of total Billed Charges,41.54,62,,33.232,percent of total Billed Charges,62% of total Billed Charges,13.59,56.95,
99999 - Bill Only Drug Screen 10 Panel,141310,CDM,301,RC,80307,HCPCS,Outpatient,,,55,38.5,,44,80,,35.2,percent of total Billed Charges,80% of Total Billed Charges,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,46.75,85,,37.4,percent of total Billed Charges,85% of total Billed Charges,44,80,,35.2,percent of total Billed Charges,80% of total Billed Charges,62.76,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,44,80,,35.2,percent of total Billed Charges,80% of Total Billed Charges,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,44,62.76,
99999 - Bill Only Drug Screen 11 Panel,141022,CDM,301,RC,80307,HCPCS,Outpatient,,,77,53.9,,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,65.45,85,,52.36,percent of total Billed Charges,85% of total Billed Charges,61.6,80,,49.28,percent of total Billed Charges,80% of total Billed Charges,62.76,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.16,65.45,
99999 - Bill Only Drug Screen 13 Panel,140916,CDM,301,RC,80307,HCPCS,Outpatient,,,85,59.5,,68,80,,54.4,percent of total Billed Charges,80% of Total Billed Charges,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,72.25,85,,57.8,percent of total Billed Charges,85% of total Billed Charges,68,80,,54.4,percent of total Billed Charges,80% of total Billed Charges,62.76,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,68,80,,54.4,percent of total Billed Charges,80% of Total Billed Charges,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.16,72.25,
99999 - Bill Only Drug Screen 7 Panel,140316,CDM,301,RC,80307,HCPCS,Outpatient,,,35,24.5,,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.75,85,,23.8,percent of total Billed Charges,85% of total Billed Charges,28,80,,22.4,percent of total Billed Charges,80% of total Billed Charges,62.76,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28,62.76,
99999 - Bill Only Drug Screen 9 Panel,140894,CDM,301,RC,80307,HCPCS,Outpatient,,,40,28,,32,80,,25.6,percent of total Billed Charges,80% of Total Billed Charges,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34,85,,27.2,percent of total Billed Charges,85% of total Billed Charges,32,80,,25.6,percent of total Billed Charges,80% of total Billed Charges,62.76,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,61.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,32,80,,25.6,percent of total Billed Charges,80% of Total Billed Charges,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,62.14,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,32,62.76,
82803 - Blood Gas Arterial,140845,CDM,301,RC,82803,HCPCS,Outpatient,,,118,82.6,,94.4,80,,75.52,percent of total Billed Charges,80% of Total Billed Charges,24.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,26.07,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,100.3,85,,80.24,percent of total Billed Charges,85% of total Billed Charges,94.4,80,,75.52,percent of total Billed Charges,80% of total Billed Charges,26.33,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,24.34,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,26.07,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.83,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,26.07,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,94.4,80,,75.52,percent of total Billed Charges,80% of Total Billed Charges,26.07,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.07,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.34,100.3,
82803 - Blood Gas Venous,140845,CDM,301,RC,82803,HCPCS,Outpatient,,,118,82.6,,94.4,80,,75.52,percent of total Billed Charges,80% of Total Billed Charges,24.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,26.07,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,100.3,85,,80.24,percent of total Billed Charges,85% of total Billed Charges,94.4,80,,75.52,percent of total Billed Charges,80% of total Billed Charges,26.33,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,24.34,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,26.07,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.83,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,26.07,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,94.4,80,,75.52,percent of total Billed Charges,80% of Total Billed Charges,26.07,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.07,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.34,100.3,
82803 - Blood Gas Venous,140845,CDM,301,RC,82803,HCPCS,Outpatient,,,118,82.6,,94.4,80,,75.52,percent of total Billed Charges,80% of Total Billed Charges,24.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,26.07,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,100.3,85,,80.24,percent of total Billed Charges,85% of total Billed Charges,94.4,80,,75.52,percent of total Billed Charges,80% of total Billed Charges,26.33,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,24.34,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,26.07,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.83,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,26.07,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,94.4,80,,75.52,percent of total Billed Charges,80% of Total Billed Charges,26.07,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.07,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.34,100.3,
84520 - Blood Urea Nitrogen,140026,CDM,301,RC,84520,HCPCS,Outpatient,,,22,15.4,,17.6,80,,14.08,percent of total Billed Charges,80% of Total Billed Charges,4.96,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.96,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.7,85,,14.96,percent of total Billed Charges,85% of total Billed Charges,17.6,80,,14.08,percent of total Billed Charges,80% of total Billed Charges,3.99,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.96,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,3.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.06,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,3.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.6,80,,14.08,percent of total Billed Charges,80% of Total Billed Charges,3.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.95,18.7,
84080 - Bone Frac LC,140011,CDM,301,RC,84080,HCPCS,Outpatient,,,82,57.4,,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,18.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.78,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,69.7,85,,55.76,percent of total Billed Charges,85% of total Billed Charges,65.6,80,,52.48,percent of total Billed Charges,80% of total Billed Charges,14.93,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,18.59,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.78,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.96,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.78,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,14.78,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.78,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.78,69.7,
140424 - C-Peptide LC,84681,CDM,301,RC,84681,HCPCS,Outpatient,,,116,81.2,,92.8,80,,74.24,percent of total Billed Charges,80% of Total Billed Charges,19.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,98.6,85,,78.88,percent of total Billed Charges,85% of total Billed Charges,92.8,80,,74.24,percent of total Billed Charges,80% of total Billed Charges,21.02,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,19.98,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,20.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,20.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,92.8,80,,74.24,percent of total Billed Charges,80% of Total Billed Charges,20.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.98,98.6,
85027 - CBC without Differential,141311,CDM,301,RC,85027,HCPCS,Outpatient,,,30,21,,24,80,,19.2,percent of total Billed Charges,80% of Total Billed Charges,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.5,85,,20.4,percent of total Billed Charges,85% of total Billed Charges,24,80,,19.2,percent of total Billed Charges,80% of total Billed Charges,6.53,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.14,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.3,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24,80,,19.2,percent of total Billed Charges,80% of Total Billed Charges,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.47,25.5,
140037 - CEA LC,82378,CDM,301,RC,82378,HCPCS,Outpatient,,,105,73.5,,84,80,,67.2,percent of total Billed Charges,80% of Total Billed Charges,23.86,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.96,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.86,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,89.25,85,,71.4,percent of total Billed Charges,85% of total Billed Charges,84,80,,67.2,percent of total Billed Charges,80% of total Billed Charges,19.15,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,23.86,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,18.96,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.34,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,18.96,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,84,80,,67.2,percent of total Billed Charges,80% of Total Billed Charges,18.96,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.96,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.96,89.25,
82550 - CK Total LC,140057,CDM,301,RC,82550,HCPCS,Outpatient,,,36,25.2,,28.8,80,,23.04,percent of total Billed Charges,80% of Total Billed Charges,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.51,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,30.6,85,,24.48,percent of total Billed Charges,85% of total Billed Charges,28.8,80,,23.04,percent of total Billed Charges,80% of total Billed Charges,6.58,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.51,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.48,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.51,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28.8,80,,23.04,percent of total Billed Charges,80% of Total Billed Charges,6.51,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.51,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.35,30.6,
82552 - CK-BB LC,140058,CDM,301,RC,82552,HCPCS,Outpatient,,,74,51.8,,59.2,80,,47.36,percent of total Billed Charges,80% of Total Billed Charges,16.84,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.84,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.9,85,,50.32,percent of total Billed Charges,85% of total Billed Charges,59.2,80,,47.36,percent of total Billed Charges,80% of total Billed Charges,13.52,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,16.84,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.18,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,59.2,80,,47.36,percent of total Billed Charges,80% of Total Billed Charges,13.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.39,62.9,
80053 - Comprehensive Metabolic Panel,140715,CDM,301,RC,80053,HCPCS,Outpatient,,,59,41.3,,47.2,80,,37.76,percent of total Billed Charges,80% of Total Billed Charges,13.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.56,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,50.15,85,,40.12,percent of total Billed Charges,85% of total Billed Charges,47.2,80,,37.76,percent of total Billed Charges,80% of total Billed Charges,10.67,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,13.29,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,10.56,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.56,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,10.56,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,47.2,80,,37.76,percent of total Billed Charges,80% of Total Billed Charges,10.56,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.56,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.56,50.15,
140817 - Calcitriol (125 di-OH Vit D) LC,82652,CDM,301,RC,82652,HCPCS,Outpatient,,,214,149.8,,171.2,80,,136.96,percent of total Billed Charges,80% of Total Billed Charges,48.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,38.5,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,48.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,181.9,85,,145.52,percent of total Billed Charges,85% of total Billed Charges,171.2,80,,136.96,percent of total Billed Charges,80% of total Billed Charges,38.89,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,48.4,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,38.5,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,49.37,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,38.5,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,171.2,80,,136.96,percent of total Billed Charges,80% of Total Billed Charges,38.5,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,38.5,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,38.5,181.9,
82310 - Calcium Level Total,140035,CDM,301,RC,82310,HCPCS,Outpatient,,,29,20.3,,23.2,80,,18.56,percent of total Billed Charges,80% of Total Billed Charges,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.16,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.65,85,,19.72,percent of total Billed Charges,85% of total Billed Charges,23.2,80,,18.56,percent of total Billed Charges,80% of total Billed Charges,5.21,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.16,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.48,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.16,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.2,80,,18.56,percent of total Billed Charges,80% of Total Billed Charges,5.16,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.16,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.16,24.65,
82340 - Calcium 24Hr Ur LC,140556,CDM,301,RC,82340,HCPCS,Outpatient,,,34,23.8,,27.2,80,,21.76,percent of total Billed Charges,80% of Total Billed Charges,7.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.03,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.9,85,,23.12,percent of total Billed Charges,85% of total Billed Charges,27.2,80,,21.76,percent of total Billed Charges,80% of total Billed Charges,6.09,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,7.59,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.03,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.74,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.03,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.2,80,,21.76,percent of total Billed Charges,80% of Total Billed Charges,6.03,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.03,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.03,28.9,
140298 - Calcium Ionized LC,82330,CDM,301,RC,82330,HCPCS,Outpatient,,,76,53.2,,60.8,80,,48.64,percent of total Billed Charges,80% of Total Billed Charges,17.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.68,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,64.6,85,,51.68,percent of total Billed Charges,85% of total Billed Charges,60.8,80,,48.64,percent of total Billed Charges,80% of total Billed Charges,13.82,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,17.18,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.68,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.52,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.68,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60.8,80,,48.64,percent of total Billed Charges,80% of Total Billed Charges,13.68,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.68,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.68,64.6,
"Calprotectin, Fecal LC",141406,CDM,301,RC,83993,HCPCS,Outpatient,,,89,62.3,,71.2,80,,56.96,percent of total Billed Charges,80% of Total Billed Charges,24.68,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,19.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.68,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,75.65,85,,60.52,percent of total Billed Charges,85% of total Billed Charges,71.2,80,,56.96,percent of total Billed Charges,80% of total Billed Charges,19.83,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,24.68,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,19.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.17,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,19.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,71.2,80,,56.96,percent of total Billed Charges,80% of Total Billed Charges,19.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.63,75.65,
140205 - Carbamazepine (Tegretol) LC,80156,CDM,301,RC,80156,HCPCS,Outpatient,,,81,56.7,,64.8,80,,51.84,percent of total Billed Charges,80% of Total Billed Charges,18.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.85,85,,55.08,percent of total Billed Charges,85% of total Billed Charges,64.8,80,,51.84,percent of total Billed Charges,80% of total Billed Charges,14.72,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,18.31,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.68,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,64.8,80,,51.84,percent of total Billed Charges,80% of Total Billed Charges,14.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.57,68.85,
82374 - Carbon Dioxide Level,140036,CDM,301,RC,82374,HCPCS,Outpatient,,,27,18.9,,21.6,80,,17.28,percent of total Billed Charges,80% of Total Billed Charges,6.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.88,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.95,85,,18.36,percent of total Billed Charges,85% of total Billed Charges,21.6,80,,17.28,percent of total Billed Charges,80% of total Billed Charges,4.93,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.15,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,4.88,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.27,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,4.88,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.6,80,,17.28,percent of total Billed Charges,80% of Total Billed Charges,4.88,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.88,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.88,22.95,
140040 - Catecholamines LC,82384,CDM,301,RC,82384,HCPCS,Outpatient,,,140,98,,112,80,,89.6,percent of total Billed Charges,80% of Total Billed Charges,31.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,31.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,119,85,,95.2,percent of total Billed Charges,85% of total Billed Charges,112,80,,89.6,percent of total Billed Charges,80% of total Billed Charges,25.5,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,31.75,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,25.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,32.39,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,25.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,112,80,,89.6,percent of total Billed Charges,80% of Total Billed Charges,25.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.25,119,
82384 - Catecholamines Free 24Hr Ur LC,140040,CDM,301,RC,82384,HCPCS,Outpatient,,,140,98,,112,80,,89.6,percent of total Billed Charges,80% of Total Billed Charges,31.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,31.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,119,85,,95.2,percent of total Billed Charges,85% of total Billed Charges,112,80,,89.6,percent of total Billed Charges,80% of total Billed Charges,25.5,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,31.75,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,25.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,32.39,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,25.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,112,80,,89.6,percent of total Billed Charges,80% of Total Billed Charges,25.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.25,119,
140289 - Ceruloplasmin LC,82390,CDM,301,RC,82390,HCPCS,Outpatient,,,60,42,,48,80,,38.4,percent of total Billed Charges,80% of Total Billed Charges,13.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51,85,,40.8,percent of total Billed Charges,85% of total Billed Charges,48,80,,38.4,percent of total Billed Charges,80% of total Billed Charges,10.85,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,13.51,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,10.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.78,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,10.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,48,80,,38.4,percent of total Billed Charges,80% of Total Billed Charges,10.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.74,51,
82435 - Chloride Level,140042,CDM,301,RC,82435,HCPCS,Outpatient,,,26,18.2,,20.8,80,,16.64,percent of total Billed Charges,80% of Total Billed Charges,5.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.1,85,,17.68,percent of total Billed Charges,85% of total Billed Charges,20.8,80,,16.64,percent of total Billed Charges,80% of total Billed Charges,4.65,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,5.78,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,4.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.9,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,4.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.8,80,,16.64,percent of total Billed Charges,80% of Total Billed Charges,4.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.6,22.1,
"Chloride, Ur LC",141188,CDM,301,RC,82436,HCPCS,Outpatient,,,28,19.6,,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.8,85,,19.04,percent of total Billed Charges,85% of total Billed Charges,22.4,80,,17.92,percent of total Billed Charges,80% of total Billed Charges,5.81,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.32,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.45,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,5.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.75,23.8,
141189 - Citric Acid (Citrate) Ur LC,82507,CDM,301,RC,82507,HCPCS,Outpatient,,,155,108.5,,124,80,,99.2,percent of total Billed Charges,80% of Total Billed Charges,34.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,34.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,131.75,85,,105.4,percent of total Billed Charges,85% of total Billed Charges,124,80,,99.2,percent of total Billed Charges,80% of total Billed Charges,28.08,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,34.97,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,27.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,35.67,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,27.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,124,80,,99.2,percent of total Billed Charges,80% of Total Billed Charges,27.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.8,131.75,
83018 - Cobalt LC,141413,CDM,301,RC,83018,HCPCS,Outpatient,,,121,84.7,,96.8,80,,77.44,percent of total Billed Charges,80% of Total Billed Charges,27.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.96,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,102.85,85,,82.28,percent of total Billed Charges,85% of total Billed Charges,96.8,80,,77.44,percent of total Billed Charges,80% of total Billed Charges,22.18,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,27.61,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,21.96,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28.16,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,21.96,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,96.8,80,,77.44,percent of total Billed Charges,80% of Total Billed Charges,21.96,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.96,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.96,102.85,
140580 - Copper LC,82525,CDM,301,RC,82525,HCPCS,Outpatient,,,69,48.3,,55.2,80,,44.16,percent of total Billed Charges,80% of Total Billed Charges,15.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.41,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,58.65,85,,46.92,percent of total Billed Charges,85% of total Billed Charges,55.2,80,,44.16,percent of total Billed Charges,80% of total Billed Charges,12.53,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.61,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.41,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.92,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.41,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,55.2,80,,44.16,percent of total Billed Charges,80% of Total Billed Charges,12.41,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.41,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.41,58.65,
140580 - Copper WB LC,82525,CDM,301,RC,82525,HCPCS,Outpatient,,,69,48.3,,55.2,80,,44.16,percent of total Billed Charges,80% of Total Billed Charges,15.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.41,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,58.65,85,,46.92,percent of total Billed Charges,85% of total Billed Charges,55.2,80,,44.16,percent of total Billed Charges,80% of total Billed Charges,12.53,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.61,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.41,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.92,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.41,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,55.2,80,,44.16,percent of total Billed Charges,80% of Total Billed Charges,12.41,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.41,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.41,58.65,
Cortisol - AM LC,140056,CDM,301,RC,82533,HCPCS,Outpatient,,,91,63.7,,72.8,80,,58.24,percent of total Billed Charges,80% of Total Billed Charges,20.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,77.35,85,,61.88,percent of total Billed Charges,85% of total Billed Charges,72.8,80,,58.24,percent of total Billed Charges,80% of total Billed Charges,16.46,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,20.5,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.91,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,72.8,80,,58.24,percent of total Billed Charges,80% of Total Billed Charges,16.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.3,77.35,
140056 - Cortisol LC,82533,CDM,301,RC,82533,HCPCS,Outpatient,,,91,63.7,,72.8,80,,58.24,percent of total Billed Charges,80% of Total Billed Charges,20.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,77.35,85,,61.88,percent of total Billed Charges,85% of total Billed Charges,72.8,80,,58.24,percent of total Billed Charges,80% of total Billed Charges,16.46,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,20.5,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.91,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,72.8,80,,58.24,percent of total Billed Charges,80% of Total Billed Charges,16.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.3,77.35,
140991 - Cortisol Urinary Free LC,82530,CDM,301,RC,82530,HCPCS,Outpatient,,,101,70.7,,80.8,80,,64.64,percent of total Billed Charges,80% of Total Billed Charges,21.02,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.02,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.85,85,,68.68,percent of total Billed Charges,85% of total Billed Charges,80.8,80,,64.64,percent of total Billed Charges,80% of total Billed Charges,16.88,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,21.02,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.44,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80.8,80,,64.64,percent of total Billed Charges,80% of Total Billed Charges,16.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.71,85.85,
82570 - Creat Ur LC,140060,CDM,301,RC,82570,HCPCS,Outpatient,,,53,37.1,,42.4,80,,33.92,percent of total Billed Charges,80% of Total Billed Charges,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.05,85,,36.04,percent of total Billed Charges,85% of total Billed Charges,42.4,80,,33.92,percent of total Billed Charges,80% of total Billed Charges,5.23,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.51,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.64,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.4,80,,33.92,percent of total Billed Charges,80% of Total Billed Charges,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.18,45.05,
82570 - Creat Ur LC,140060,CDM,301,RC,82570,HCPCS,Outpatient,,,53,37.1,,42.4,80,,33.92,percent of total Billed Charges,80% of Total Billed Charges,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.05,85,,36.04,percent of total Billed Charges,85% of total Billed Charges,42.4,80,,33.92,percent of total Billed Charges,80% of total Billed Charges,5.23,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.51,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.64,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.4,80,,33.92,percent of total Billed Charges,80% of Total Billed Charges,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.18,45.05,
82550 - Creatine Kinase,140057,CDM,301,RC,82550,HCPCS,Outpatient,,,36,25.2,,28.8,80,,23.04,percent of total Billed Charges,80% of Total Billed Charges,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.51,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,30.6,85,,24.48,percent of total Billed Charges,85% of total Billed Charges,28.8,80,,23.04,percent of total Billed Charges,80% of total Billed Charges,6.58,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.51,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.48,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.51,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28.8,80,,23.04,percent of total Billed Charges,80% of Total Billed Charges,6.51,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.51,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.35,30.6,
82565 - Creatinine,140059,CDM,301,RC,82565,HCPCS,Outpatient,,,28,19.6,,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.8,85,,19.04,percent of total Billed Charges,85% of total Billed Charges,22.4,80,,17.92,percent of total Billed Charges,80% of total Billed Charges,5.17,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.48,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,5.12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.12,23.8,
140061 - Creatinine Clearance LC,82575,CDM,301,RC,82575,HCPCS,Outpatient,,,53,37.1,,42.4,80,,33.92,percent of total Billed Charges,80% of Total Billed Charges,11.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.46,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.05,85,,36.04,percent of total Billed Charges,85% of total Billed Charges,42.4,80,,33.92,percent of total Billed Charges,80% of total Billed Charges,9.55,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,11.88,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,9.46,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.12,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,9.46,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.4,80,,33.92,percent of total Billed Charges,80% of Total Billed Charges,9.46,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.46,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.46,45.05,
82570 - Creatinine 24-Hr Ur LC,140060,CDM,301,RC,82570,HCPCS,Outpatient,,,53,37.1,,42.4,80,,33.92,percent of total Billed Charges,80% of Total Billed Charges,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.05,85,,36.04,percent of total Billed Charges,85% of total Billed Charges,42.4,80,,33.92,percent of total Billed Charges,80% of total Billed Charges,5.23,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.51,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.64,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.4,80,,33.92,percent of total Billed Charges,80% of Total Billed Charges,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.18,45.05,
140060 - Creatinine Random Ur LC,82570,CDM,301,RC,82570,HCPCS,Outpatient,,,53,37.1,,42.4,80,,33.92,percent of total Billed Charges,80% of Total Billed Charges,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.05,85,,36.04,percent of total Billed Charges,85% of total Billed Charges,42.4,80,,33.92,percent of total Billed Charges,80% of total Billed Charges,5.23,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.51,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.64,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.4,80,,33.92,percent of total Billed Charges,80% of Total Billed Charges,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.18,45.05,
140595 - Cryoglobulin Ql Rflx LC,82595,CDM,301,RC,82595,HCPCS,Outpatient,,,36,25.2,,28.8,80,,23.04,percent of total Billed Charges,80% of Total Billed Charges,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,30.6,85,,24.48,percent of total Billed Charges,85% of total Billed Charges,28.8,80,,23.04,percent of total Billed Charges,80% of total Billed Charges,6.53,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.14,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.3,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28.8,80,,23.04,percent of total Billed Charges,80% of Total Billed Charges,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.47,30.6,
Cystatin C LC,141160,CDM,301,RC,82610,HCPCS,Outpatient,,,83,58.1,,66.4,80,,53.12,percent of total Billed Charges,80% of Total Billed Charges,17.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,70.55,85,,56.44,percent of total Billed Charges,85% of total Billed Charges,66.4,80,,53.12,percent of total Billed Charges,80% of total Billed Charges,18.71,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,17.1,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,18.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.44,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,18.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,66.4,80,,53.12,percent of total Billed Charges,80% of Total Billed Charges,18.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.1,70.55,
D001-IgE D pteronyssinus LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
D002-IgE D farinae LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
141005 - DHEA Serum LC,82626,CDM,301,RC,82626,HCPCS,Outpatient,,,140,98,,112,80,,89.6,percent of total Billed Charges,80% of Total Billed Charges,31.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,31.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,119,85,,95.2,percent of total Billed Charges,85% of total Billed Charges,112,80,,89.6,percent of total Billed Charges,80% of total Billed Charges,25.52,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,31.78,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,25.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,32.42,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,25.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,112,80,,89.6,percent of total Billed Charges,80% of Total Billed Charges,25.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.27,119,
140241 - DHEA-Sulfate LC,82627,CDM,301,RC,82627,HCPCS,Outpatient,,,124,86.8,,99.2,80,,79.36,percent of total Billed Charges,80% of Total Billed Charges,27.96,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.23,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.96,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,105.4,85,,84.32,percent of total Billed Charges,85% of total Billed Charges,99.2,80,,79.36,percent of total Billed Charges,80% of total Billed Charges,22.45,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,27.96,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,22.23,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28.52,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,22.23,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,99.2,80,,79.36,percent of total Billed Charges,80% of Total Billed Charges,22.23,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.23,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.23,105.4,
80162 - Digoxin LvL,140083,CDM,301,RC,80162,HCPCS,Outpatient,,,74,51.8,,59.2,80,,47.36,percent of total Billed Charges,80% of Total Billed Charges,16.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.9,85,,50.32,percent of total Billed Charges,85% of total Billed Charges,59.2,80,,47.36,percent of total Billed Charges,80% of total Billed Charges,13.41,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,16.7,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.03,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,59.2,80,,47.36,percent of total Billed Charges,80% of Total Billed Charges,13.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.28,62.9,
141163 - Dihydrotestosterone LC,82642,CDM,301,RC,82642,HCPCS,Outpatient,,,75,52.5,,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,26.02,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.02,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,63.75,85,,51,percent of total Billed Charges,85% of total Billed Charges,60,80,,48,percent of total Billed Charges,80% of total Billed Charges,29.57,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,26.02,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,29.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.54,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,29.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,29.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,29.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.02,63.75,
E001-IgE Cat Dander LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
E005-IgE Dog Dander LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
80051 - Electrolyte Panel,140571,CDM,301,RC,80051,HCPCS,Outpatient,,,39,27.3,,31.2,80,,24.96,percent of total Billed Charges,80% of Total Billed Charges,8.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.01,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,33.15,85,,26.52,percent of total Billed Charges,85% of total Billed Charges,31.2,80,,24.96,percent of total Billed Charges,80% of total Billed Charges,7.08,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.82,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,7.01,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,7.01,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,31.2,80,,24.96,percent of total Billed Charges,80% of Total Billed Charges,7.01,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.01,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.01,33.15,
140594 - Erythropoietin (EPO) LC,82668,CDM,301,RC,82668,HCPCS,Outpatient,,,104,72.8,,83.2,80,,66.56,percent of total Billed Charges,80% of Total Billed Charges,23.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.79,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,88.4,85,,70.72,percent of total Billed Charges,85% of total Billed Charges,83.2,80,,66.56,percent of total Billed Charges,80% of total Billed Charges,18.98,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,23.63,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,18.79,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.1,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,18.79,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,83.2,80,,66.56,percent of total Billed Charges,80% of Total Billed Charges,18.79,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.79,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.79,88.4,
140675 - Estradiol LC,82670,CDM,301,RC,82670,HCPCS,Outpatient,,,155,108.5,,124,80,,99.2,percent of total Billed Charges,80% of Total Billed Charges,35.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,35.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,131.75,85,,105.4,percent of total Billed Charges,85% of total Billed Charges,124,80,,99.2,percent of total Billed Charges,80% of total Billed Charges,28.22,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,35.14,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,27.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,35.84,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,27.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,124,80,,99.2,percent of total Billed Charges,80% of Total Billed Charges,27.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.94,131.75,
82670 - Estradiol Sensitive LC,140675,CDM,301,RC,82670,HCPCS,Outpatient,,,155,108.5,,124,80,,99.2,percent of total Billed Charges,80% of Total Billed Charges,35.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,35.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,131.75,85,,105.4,percent of total Billed Charges,85% of total Billed Charges,124,80,,99.2,percent of total Billed Charges,80% of total Billed Charges,28.22,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,35.14,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,27.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,35.84,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,27.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,124,80,,99.2,percent of total Billed Charges,80% of Total Billed Charges,27.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.94,131.75,
80320 - Alcohol Level,140008,CDM,301,RC,80320|G048,HCPCS,Outpatient,,,515,360.5,,412,80,,329.6,percent of total Billed Charges,80% of Total Billed Charges,324.45,63,,259.56,percent of total Billed charges,63% of Total Billed Charges,319.3,62,,255.44,percent of total Billed Charges,62% of total BIlled charges,324.45,63,,259.56,percent of total Billed Charges,63% of total Billed Charges,437.75,85,,350.2,percent of total Billed Charges,85% of total Billed Charges,412,80,,329.6,percent of total Billed Charges,80% of total Billed Charges,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,324.45,63,,259.56,percent of total Billed Charges,63% of total Billed Charges,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,324.45,63,,259.56,percent of total billed charges,63% of total Billed Charges,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,412,80,,329.6,percent of total Billed Charges,80% of Total Billed Charges,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,319.3,437.75,
86003 - F002-IgE Milk LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
86003 - F002-IgE Milk LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
86003 - F002-IgE Milk LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
86003 - F002-IgE Milk LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
86003 - F002-IgE Milk LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
86003 - F013-IgE Peanut LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
86003 - F002-IgE Milk LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
86003 - F002-IgE Milk LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
86003 - F002-IgE Milk LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
86003 - F024-IgE Shrimp LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
86003 - F026-IgE Pork LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
86003 - F027-IgE Beef LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
86003 - F002-IgE Milk LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
86003 - F088-IgE Lamb LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
86003 - F002-IgE Milk LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
86003 - F002-IgE Milk LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
86003 - F245-IgE Egg Whole LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
86003 - F002-IgE Milk LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
140100 - FSH LC,83001,CDM,301,RC,83001,HCPCS,Outpatient,,,103,72.1,,82.4,80,,65.92,percent of total Billed Charges,80% of Total Billed Charges,23.37,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.37,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,87.55,85,,70.04,percent of total Billed Charges,85% of total Billed Charges,82.4,80,,65.92,percent of total Billed Charges,80% of total Billed Charges,18.77,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,23.37,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,18.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.84,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,18.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,82.4,80,,65.92,percent of total Billed Charges,80% of Total Billed Charges,18.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.58,87.55,
83001 - FSH LC,140100,CDM,301,RC,83001,HCPCS,Outpatient,,,103,72.1,,82.4,80,,65.92,percent of total Billed Charges,80% of Total Billed Charges,23.37,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.37,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,87.55,85,,70.04,percent of total Billed Charges,85% of total Billed Charges,82.4,80,,65.92,percent of total Billed Charges,80% of total Billed Charges,18.77,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,23.37,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,18.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.84,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,18.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,82.4,80,,65.92,percent of total Billed Charges,80% of Total Billed Charges,18.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.58,87.55,
140504 - Fecal Fat Qual LC,82705,CDM,301,RC,82705,HCPCS,Outpatient,,,28,19.6,,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,6.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.4,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.8,85,,19.04,percent of total Billed Charges,85% of total Billed Charges,22.4,80,,17.92,percent of total Billed Charges,80% of total Billed Charges,5.15,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.4,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.53,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,5.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.1,23.8,
140095 - Ferritin Serum LC,82728,CDM,301,RC,82728,HCPCS,Outpatient,,,76,53.2,,60.8,80,,48.64,percent of total Billed Charges,80% of Total Billed Charges,17.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,64.6,85,,51.68,percent of total Billed Charges,85% of total Billed Charges,60.8,80,,48.64,percent of total Billed Charges,80% of total Billed Charges,13.77,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,17.13,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.47,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60.8,80,,48.64,percent of total Billed Charges,80% of Total Billed Charges,13.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.63,64.6,
140099 - Folate (Folic Acid) LC,82746,CDM,301,RC,82746,HCPCS,Outpatient,,,82,57.4,,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,18.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,69.7,85,,55.76,percent of total Billed Charges,85% of total Billed Charges,65.6,80,,52.48,percent of total Billed Charges,80% of total Billed Charges,14.85,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,18.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.86,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,14.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.7,69.7,
82746 - Folate LC,140099,CDM,301,RC,82746,HCPCS,Outpatient,,,82,57.4,,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,18.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,69.7,85,,55.76,percent of total Billed Charges,85% of total Billed Charges,65.6,80,,52.48,percent of total Billed Charges,80% of total Billed Charges,14.85,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,18.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.86,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,14.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.7,69.7,
82747 - Folate RBC LC,140621,CDM,301,RC,82747,HCPCS,Outpatient,,,96,67.2,,76.8,80,,61.44,percent of total Billed Charges,80% of Total Billed Charges,21.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,81.6,85,,65.28,percent of total Billed Charges,85% of total Billed Charges,76.8,80,,61.44,percent of total Billed Charges,80% of total Billed Charges,17.83,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,21.78,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.22,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,76.8,80,,61.44,percent of total Billed Charges,80% of Total Billed Charges,17.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.65,81.6,
84402 - Free Testost Direct LC,140242,CDM,301,RC,84402,HCPCS,Outpatient,,,142,99.4,,113.6,80,,90.88,percent of total Billed Charges,80% of Total Billed Charges,32.01,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,32.01,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,120.7,85,,96.56,percent of total Billed Charges,85% of total Billed Charges,113.6,80,,90.88,percent of total Billed Charges,80% of total Billed Charges,25.72,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,32.01,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,25.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,32.65,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,25.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,113.6,80,,90.88,percent of total Billed Charges,80% of Total Billed Charges,25.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.47,120.7,
141515 - Fructosamine LC,82985,CDM,301,RC,82985,HCPCS,Outpatient,,,84,58.8,,67.2,80,,53.76,percent of total Billed Charges,80% of Total Billed Charges,18.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.76,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,71.4,85,,57.12,percent of total Billed Charges,85% of total Billed Charges,67.2,80,,53.76,percent of total Billed Charges,80% of total Billed Charges,16.93,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,18.95,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.76,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.33,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.76,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,67.2,80,,53.76,percent of total Billed Charges,80% of Total Billed Charges,16.76,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.76,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.76,71.4,
G006-IgE Timothy Grass LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
140104 - GGT LC,82977,CDM,301,RC,82977,HCPCS,Outpatient,,,40,28,,32,80,,25.6,percent of total Billed Charges,80% of Total Billed Charges,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.2,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34,85,,27.2,percent of total Billed Charges,85% of total Billed Charges,32,80,,25.6,percent of total Billed Charges,80% of total Billed Charges,7.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,7.2,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.48,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,7.2,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,32,80,,25.6,percent of total Billed Charges,80% of Total Billed Charges,7.2,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.2,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.35,34,
140105 - Gentamicin Serum Trough LC,80170,CDM,301,RC,80170,HCPCS,Outpatient,,,91,63.7,,72.8,80,,58.24,percent of total Billed Charges,80% of Total Billed Charges,20.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.38,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,77.35,85,,61.88,percent of total Billed Charges,85% of total Billed Charges,72.8,80,,58.24,percent of total Billed Charges,80% of total Billed Charges,16.54,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,20.61,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.38,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.02,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.38,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,72.8,80,,58.24,percent of total Billed Charges,80% of Total Billed Charges,16.38,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.38,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.38,77.35,
82951 - Glucose 2 Hour,140107,CDM,301,RC,82951,HCPCS,Outpatient,,,72,50.4,,57.6,80,,46.08,percent of total Billed Charges,80% of Total Billed Charges,16.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.87,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.2,85,,48.96,percent of total Billed Charges,85% of total Billed Charges,57.6,80,,46.08,percent of total Billed Charges,80% of total Billed Charges,13,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,16.19,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.87,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.51,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.87,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,57.6,80,,46.08,percent of total Billed Charges,80% of Total Billed Charges,12.87,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.87,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.87,61.2,
82952 - Glucose 3 Hour,140108,CDM,301,RC,82952,HCPCS,Outpatient,,,22,15.4,,17.6,80,,14.08,percent of total Billed Charges,80% of Total Billed Charges,4.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.7,85,,14.96,percent of total Billed Charges,85% of total Billed Charges,17.6,80,,14.08,percent of total Billed Charges,80% of total Billed Charges,3.96,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.93,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,3.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.03,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,3.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.6,80,,14.08,percent of total Billed Charges,80% of Total Billed Charges,3.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.92,18.7,
82947 - Glucose Level,140106,CDM,301,RC,82947,HCPCS,Outpatient,,,22,15.4,,17.6,80,,14.08,percent of total Billed Charges,80% of Total Billed Charges,4.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.7,85,,14.96,percent of total Billed Charges,85% of total Billed Charges,17.6,80,,14.08,percent of total Billed Charges,80% of total Billed Charges,3.97,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.93,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,3.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.03,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,3.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.6,80,,14.08,percent of total Billed Charges,80% of Total Billed Charges,3.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.93,18.7,
Growth Hormone LC,140118,CDM,301,RC,83003,HCPCS,Outpatient,,,89,62.3,,71.2,80,,56.96,percent of total Billed Charges,80% of Total Billed Charges,17.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,75.65,85,,60.52,percent of total Billed Charges,85% of total Billed Charges,71.2,80,,56.96,percent of total Billed Charges,80% of total Billed Charges,16.84,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,17.9,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.26,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,71.2,80,,56.96,percent of total Billed Charges,80% of Total Billed Charges,16.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.67,75.65,
82271 - Guaiac Gastric,140914,CDM,301,RC,82271,HCPCS,Outpatient,,,24,16.8,,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,4.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.04,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.4,85,,16.32,percent of total Billed Charges,85% of total Billed Charges,19.2,80,,15.36,percent of total Billed Charges,80% of total Billed Charges,5.37,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.04,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.12,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,5.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.04,20.4,
140110 - Haptoglobin LC,83010,CDM,301,RC,83010,HCPCS,Outpatient,,,70,49,,56,80,,44.8,percent of total Billed Charges,80% of Total Billed Charges,4.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,59.5,85,,47.6,percent of total Billed Charges,85% of total Billed Charges,56,80,,44.8,percent of total Billed Charges,80% of total Billed Charges,12.71,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.78,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,56,80,,44.8,percent of total Billed Charges,80% of Total Billed Charges,12.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.69,59.5,
Hemoglobinopathy Fractionation Cascade LC,140087,CDM,301,RC,83020,HCPCS,Outpatient,,,72,50.4,,57.6,80,,46.08,percent of total Billed Charges,80% of Total Billed Charges,12.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.87,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.2,85,,48.96,percent of total Billed Charges,85% of total Billed Charges,57.6,80,,46.08,percent of total Billed Charges,80% of total Billed Charges,13,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,12.29,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.87,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.54,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.87,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,57.6,80,,46.08,percent of total Billed Charges,80% of Total Billed Charges,12.87,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.87,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.29,61.2,
80076 - Hep Fnct Pnl,140356,CDM,301,RC,80076,HCPCS,Outpatient,,,45,31.5,,36,80,,28.8,percent of total Billed Charges,80% of Total Billed Charges,10.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,38.25,85,,30.6,percent of total Billed Charges,85% of total Billed Charges,36,80,,28.8,percent of total Billed Charges,80% of total Billed Charges,8.25,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.28,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.49,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,36,80,,28.8,percent of total Billed Charges,80% of Total Billed Charges,8.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.17,38.25,
140712 - Hep Panel (4) LC,80074,CDM,301,RC,80074,HCPCS,Outpatient,,,265,185.5,,212,80,,169.6,percent of total Billed Charges,80% of Total Billed Charges,59.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,59.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,225.25,85,,180.2,percent of total Billed Charges,85% of total Billed Charges,212,80,,169.6,percent of total Billed Charges,80% of total Billed Charges,48.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,59.89,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,47.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.09,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,47.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,212,80,,169.6,percent of total Billed Charges,80% of Total Billed Charges,47.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,47.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,47.63,225.25,
83036 - Hgb A1c w/eAG,141171,CDM,301,RC,83036,HCPCS,Outpatient,,,54,37.8,,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.9,85,,36.72,percent of total Billed Charges,85% of total Billed Charges,43.2,80,,34.56,percent of total Billed Charges,80% of total Billed Charges,9.81,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,12.2,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,9.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.44,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,9.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,9.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.71,45.9,
141171 - Hgb A1c with eAG Estimation LC,83036,CDM,301,RC,83036,HCPCS,Outpatient,,,54,37.8,,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.9,85,,36.72,percent of total Billed Charges,85% of total Billed Charges,43.2,80,,34.56,percent of total Billed Charges,80% of total Billed Charges,9.81,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,12.2,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,9.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.44,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,9.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,9.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.71,45.9,
83090 - Homocyst(e)ine LC,141470,CDM,301,RC,83090,HCPCS,Outpatient,,,81,56.7,,64.8,80,,51.84,percent of total Billed Charges,80% of Total Billed Charges,21.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.85,85,,55.08,percent of total Billed Charges,85% of total Billed Charges,64.8,80,,51.84,percent of total Billed Charges,80% of total Billed Charges,18.1,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,21.21,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.63,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,64.8,80,,51.84,percent of total Billed Charges,80% of Total Billed Charges,17.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.92,68.85,
IGF-1 LC,141492,CDM,301,RC,84305,HCPCS,Outpatient,,,96,67.2,,76.8,80,,61.44,percent of total Billed Charges,80% of Total Billed Charges,26.73,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.73,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,81.6,85,,65.28,percent of total Billed Charges,85% of total Billed Charges,76.8,80,,61.44,percent of total Billed Charges,80% of total Billed Charges,21.47,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,26.73,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,21.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.26,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,21.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,76.8,80,,61.44,percent of total Billed Charges,80% of Total Billed Charges,21.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.26,81.6,
140124 - Immunoglobulin A Qn LC,82784,CDM,301,RC,82784,HCPCS,Outpatient,,,52,36.4,,41.6,80,,33.28,percent of total Billed Charges,80% of Total Billed Charges,11.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,44.2,85,,35.36,percent of total Billed Charges,85% of total Billed Charges,41.6,80,,33.28,percent of total Billed Charges,80% of total Billed Charges,9.39,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,11.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,9.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.92,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,9.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,41.6,80,,33.28,percent of total Billed Charges,80% of Total Billed Charges,9.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.3,44.2,
"Immunoglobulin E, Total LC",140126,CDM,301,RC,82785,HCPCS,Outpatient,,,91,63.7,,72.8,80,,58.24,percent of total Billed Charges,80% of Total Billed Charges,20.71,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.46,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.71,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,77.35,85,,61.88,percent of total Billed Charges,85% of total Billed Charges,72.8,80,,58.24,percent of total Billed Charges,80% of total Billed Charges,16.62,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,20.71,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.46,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.12,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.46,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,72.8,80,,58.24,percent of total Billed Charges,80% of Total Billed Charges,16.46,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.46,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.46,77.35,
82784 - Immunoglobulin G Qn LC,140124,CDM,301,RC,82784,HCPCS,Outpatient,,,52,36.4,,41.6,80,,33.28,percent of total Billed Charges,80% of Total Billed Charges,11.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,44.2,85,,35.36,percent of total Billed Charges,85% of total Billed Charges,41.6,80,,33.28,percent of total Billed Charges,80% of total Billed Charges,9.39,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,11.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,9.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.92,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,9.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,41.6,80,,33.28,percent of total Billed Charges,80% of Total Billed Charges,9.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.3,44.2,
"Immunoglobulin M, Qn LC",140124,CDM,301,RC,82784,HCPCS,Outpatient,,,52,36.4,,41.6,80,,33.28,percent of total Billed Charges,80% of Total Billed Charges,11.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,44.2,85,,35.36,percent of total Billed Charges,85% of total Billed Charges,41.6,80,,33.28,percent of total Billed Charges,80% of total Billed Charges,9.39,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,11.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,9.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.92,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,9.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,41.6,80,,33.28,percent of total Billed Charges,80% of Total Billed Charges,9.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.3,44.2,
82274 - Immunological Fecal Occult Blood,141354,CDM,301,RC,82274,HCPCS,Outpatient,,,80,56,,64,80,,51.2,percent of total Billed Charges,80% of Total Billed Charges,21.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68,85,,54.4,percent of total Billed Charges,85% of total Billed Charges,64,80,,51.2,percent of total Billed Charges,80% of total Billed Charges,16.08,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,21.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,15.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.12,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,15.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,64,80,,51.2,percent of total Billed Charges,80% of Total Billed Charges,15.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.92,68,
140370 - Insulin LC,83525,CDM,301,RC,83525,HCPCS,Outpatient,,,64,44.8,,51.2,80,,40.96,percent of total Billed Charges,80% of Total Billed Charges,14.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.43,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54.4,85,,43.52,percent of total Billed Charges,85% of total Billed Charges,51.2,80,,40.96,percent of total Billed Charges,80% of total Billed Charges,11.54,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,14.38,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,11.43,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.67,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,11.43,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.2,80,,40.96,percent of total Billed Charges,80% of Total Billed Charges,11.43,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.43,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.43,54.4,
83550 - Iron Bind.Cap.(TIBC) LC,141364,CDM,301,RC,83550,HCPCS,Outpatient,,,49,34.3,,39.2,80,,31.36,percent of total Billed Charges,80% of Total Billed Charges,10.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,41.65,85,,33.32,percent of total Billed Charges,85% of total Billed Charges,39.2,80,,31.36,percent of total Billed Charges,80% of total Billed Charges,8.83,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.99,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.21,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,39.2,80,,31.36,percent of total Billed Charges,80% of Total Billed Charges,8.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.74,41.65,
83540 - Iron LC,140129,CDM,301,RC,83540,HCPCS,Outpatient,,,36,25.2,,28.8,80,,23.04,percent of total Billed Charges,80% of Total Billed Charges,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,30.6,85,,24.48,percent of total Billed Charges,85% of total Billed Charges,28.8,80,,23.04,percent of total Billed Charges,80% of total Billed Charges,6.53,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.15,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.31,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28.8,80,,23.04,percent of total Billed Charges,80% of Total Billed Charges,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.47,30.6,
140129 - Iron LC,83540,CDM,301,RC,83540,HCPCS,Outpatient,,,36,25.2,,28.8,80,,23.04,percent of total Billed Charges,80% of Total Billed Charges,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,30.6,85,,24.48,percent of total Billed Charges,85% of total Billed Charges,28.8,80,,23.04,percent of total Billed Charges,80% of total Billed Charges,6.53,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.15,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.31,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28.8,80,,23.04,percent of total Billed Charges,80% of Total Billed Charges,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.47,30.6,
86003 - F002-IgE Milk LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
LD Body Fluid LC,140133,CDM,301,RC,83615,HCPCS,Outpatient,,,34,23.8,,27.2,80,,21.76,percent of total Billed Charges,80% of Total Billed Charges,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.04,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.9,85,,23.12,percent of total Billed Charges,85% of total Billed Charges,27.2,80,,21.76,percent of total Billed Charges,80% of total Billed Charges,6.1,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.04,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.48,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.04,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.2,80,,21.76,percent of total Billed Charges,80% of Total Billed Charges,6.04,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.04,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.04,28.9,
LDL Cholesterol (Direct) LC,140969,CDM,301,RC,83721,HCPCS,Outpatient,,,53,37.1,,42.4,80,,33.92,percent of total Billed Charges,80% of Total Billed Charges,12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.5,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.05,85,,36.04,percent of total Billed Charges,85% of total Billed Charges,42.4,80,,33.92,percent of total Billed Charges,80% of total Billed Charges,10.61,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,12,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,10.5,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.24,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,10.5,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.4,80,,33.92,percent of total Billed Charges,80% of Total Billed Charges,10.5,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.5,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.5,45.05,
83002 - LH LC,140139,CDM,301,RC,83002,HCPCS,Outpatient,,,10,7,,8,80,,6.4,percent of total Billed Charges,80% of Total Billed Charges,23.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.5,85,,6.8,percent of total Billed Charges,85% of total Billed Charges,8,80,,6.4,percent of total Billed Charges,80% of total Billed Charges,18.71,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,23.29,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,18.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.76,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,18.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8,80,,6.4,percent of total Billed Charges,80% of Total Billed Charges,18.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8,23.76,
83615 - Lactate Dehydrogenase,140133,CDM,301,RC,83615,HCPCS,Outpatient,,,34,23.8,,27.2,80,,21.76,percent of total Billed Charges,80% of Total Billed Charges,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.04,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.9,85,,23.12,percent of total Billed Charges,85% of total Billed Charges,27.2,80,,21.76,percent of total Billed Charges,80% of total Billed Charges,6.1,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.04,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.48,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.04,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.2,80,,21.76,percent of total Billed Charges,80% of Total Billed Charges,6.04,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.04,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.04,28.9,
83605 - Lactic Acid Level,140254,CDM,301,RC,83605,HCPCS,Outpatient,,,59,41.3,,47.2,80,,37.76,percent of total Billed Charges,80% of Total Billed Charges,13.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,50.15,85,,40.12,percent of total Billed Charges,85% of total Billed Charges,47.2,80,,37.76,percent of total Billed Charges,80% of total Billed Charges,11.69,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,13.43,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,11.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,11.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,47.2,80,,37.76,percent of total Billed Charges,80% of Total Billed Charges,11.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.57,50.15,
"Lactoferrin, Fecal, Quant. LC",141407,CDM,301,RC,83631,HCPCS,Outpatient,,,89,62.3,,71.2,80,,56.96,percent of total Billed Charges,80% of Total Billed Charges,24.68,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,19.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.68,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,75.65,85,,60.52,percent of total Billed Charges,85% of total Billed Charges,71.2,80,,56.96,percent of total Billed Charges,80% of total Billed Charges,19.83,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,24.68,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,19.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.17,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,19.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,71.2,80,,56.96,percent of total Billed Charges,80% of Total Billed Charges,19.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.63,75.65,
"Lamotrigine (Lamictal), LC",141506,CDM,301,RC,80175,HCPCS,Outpatient,,,60,42,,48,80,,38.4,percent of total Billed Charges,80% of Total Billed Charges,14.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51,85,,40.8,percent of total Billed Charges,85% of total Billed Charges,48,80,,38.4,percent of total Billed Charges,80% of total Billed Charges,13.38,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,14.47,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.76,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,48,80,,38.4,percent of total Billed Charges,80% of Total Billed Charges,13.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.25,51,
83655 - Lead Blood LC,140720,CDM,301,RC,83655,HCPCS,Outpatient,,,67,46.9,,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,10,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.11,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.95,85,,45.56,percent of total Billed Charges,85% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of total Billed Charges,12.23,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.11,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.2,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.11,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,12.11,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.11,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10,56.95,
83655 - Lead Blood LC,140720,CDM,301,RC,83655,HCPCS,Outpatient,,,67,46.9,,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,10,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.11,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.95,85,,45.56,percent of total Billed Charges,85% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of total Billed Charges,12.23,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.11,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.2,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.11,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,12.11,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.11,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10,56.95,
83655 - Lead Bld (Pediatric) LC,140720,CDM,301,RC,83655,HCPCS,Outpatient,,,67,46.9,,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,10,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.11,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.95,85,,45.56,percent of total Billed Charges,85% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of total Billed Charges,12.23,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.11,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.2,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.11,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,12.11,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.11,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10,56.95,
140872 - Levetiracetam (Keppra) S LC,80177,CDM,301,RC,80177,HCPCS,Outpatient,,,84,58.8,,67.2,80,,53.76,percent of total Billed Charges,80% of Total Billed Charges,14.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,71.4,85,,57.12,percent of total Billed Charges,85% of total Billed Charges,67.2,80,,53.76,percent of total Billed Charges,80% of total Billed Charges,13.38,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,14.47,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.76,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,67.2,80,,53.76,percent of total Billed Charges,80% of Total Billed Charges,13.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.25,71.4,
83690 - Lipase Level,140136,CDM,301,RC,83690,HCPCS,Outpatient,,,38,26.6,,30.4,80,,24.32,percent of total Billed Charges,80% of Total Billed Charges,8.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.89,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,32.3,85,,25.84,percent of total Billed Charges,85% of total Billed Charges,30.4,80,,24.32,percent of total Billed Charges,80% of total Billed Charges,6.96,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.66,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.89,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.83,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.89,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,30.4,80,,24.32,percent of total Billed Charges,80% of Total Billed Charges,6.89,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.89,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.89,32.3,
80061 - Lipid Panel,140176,CDM,301,RC,80061,HCPCS,Outpatient,,,74,51.8,,59.2,80,,47.36,percent of total Billed Charges,80% of Total Billed Charges,16.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.9,85,,50.32,percent of total Billed Charges,85% of total Billed Charges,59.2,80,,47.36,percent of total Billed Charges,80% of total Billed Charges,13.52,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,16.85,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.19,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,59.2,80,,47.36,percent of total Billed Charges,80% of Total Billed Charges,13.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.39,62.9,
Lithium (Eskalith(R)) LC,140137,CDM,301,RC,80178,HCPCS,Outpatient,,,37,25.9,,29.6,80,,23.68,percent of total Billed Charges,80% of Total Billed Charges,8.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,31.45,85,,25.16,percent of total Billed Charges,85% of total Billed Charges,29.6,80,,23.68,percent of total Billed Charges,80% of total Billed Charges,6.68,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.32,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.49,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,29.6,80,,23.68,percent of total Billed Charges,80% of Total Billed Charges,6.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.61,31.45,
140139 - Luteinizing Hormone (LH) S LC,83002,CDM,301,RC,83002,HCPCS,Outpatient,,,10,7,,8,80,,6.4,percent of total Billed Charges,80% of Total Billed Charges,23.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.5,85,,6.8,percent of total Billed Charges,85% of total Billed Charges,8,80,,6.4,percent of total Billed Charges,80% of total Billed Charges,18.71,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,23.29,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,18.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.76,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,18.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8,80,,6.4,percent of total Billed Charges,80% of Total Billed Charges,18.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8,23.76,
M003-IgE Aspergillus fumigatus LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
M006-IgE Alternaria alternata LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
83735 - Magnesium Level,140141,CDM,301,RC,83735,HCPCS,Outpatient,,,37,25.9,,29.6,80,,23.68,percent of total Billed Charges,80% of Total Billed Charges,8.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,31.45,85,,25.16,percent of total Billed Charges,85% of total Billed Charges,29.6,80,,23.68,percent of total Billed Charges,80% of total Billed Charges,6.77,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.42,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.59,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,29.6,80,,23.68,percent of total Billed Charges,80% of Total Billed Charges,6.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,31.45,
140141 - Magnesium Ur LC,83735,CDM,301,RC,83735,HCPCS,Outpatient,,,37,25.9,,29.6,80,,23.68,percent of total Billed Charges,80% of Total Billed Charges,8.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,31.45,85,,25.16,percent of total Billed Charges,85% of total Billed Charges,29.6,80,,23.68,percent of total Billed Charges,80% of total Billed Charges,6.77,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.42,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.59,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,29.6,80,,23.68,percent of total Billed Charges,80% of Total Billed Charges,6.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,31.45,
83825 - Mercury Blood LC,140721,CDM,301,RC,83825,HCPCS,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,20.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,16.42,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,20.45,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.86,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,16.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.26,76.5,
83825 - Mercury Blood LC,140721,CDM,301,RC,83825,HCPCS,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,20.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,16.42,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,20.45,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.86,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,16.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.26,76.5,
140232 - Metanephrines Frac Qn 24-Hr LC,83835,CDM,301,RC,83835,HCPCS,Outpatient,,,94,65.8,,75.2,80,,60.16,percent of total Billed Charges,80% of Total Billed Charges,21.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,79.9,85,,63.92,percent of total Billed Charges,85% of total Billed Charges,75.2,80,,60.16,percent of total Billed Charges,80% of total Billed Charges,17.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,21.3,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.73,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,75.2,80,,60.16,percent of total Billed Charges,80% of Total Billed Charges,16.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.94,79.9,
83835 - Metanephrines Frac. Pl. Free LC,140232,CDM,301,RC,83835,HCPCS,Outpatient,,,94,65.8,,75.2,80,,60.16,percent of total Billed Charges,80% of Total Billed Charges,21.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,79.9,85,,63.92,percent of total Billed Charges,85% of total Billed Charges,75.2,80,,60.16,percent of total Billed Charges,80% of total Billed Charges,17.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,21.3,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.73,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,75.2,80,,60.16,percent of total Billed Charges,80% of Total Billed Charges,16.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.94,79.9,
"Methanol, Whole Blood or Serum LC",141507,CDM,301,RC,80320,HCPCS,Outpatient,,,515,360.5,,412,80,,329.6,percent of total Billed Charges,80% of Total Billed Charges,13.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,319.3,62,,255.44,percent of total Billed Charges,62% of total BIlled charges,13.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,437.75,85,,350.2,percent of total Billed Charges,85% of total Billed Charges,412,80,,329.6,percent of total Billed Charges,80% of total Billed Charges,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,13.59,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,13.86,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,412,80,,329.6,percent of total Billed Charges,80% of Total Billed Charges,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,319.3,62,,255.44,percent of total Billed Charges,62% of total Billed Charges,13.59,437.75,
140827 - Methylmalonic Acid LC,83921,CDM,301,RC,83921,HCPCS,Outpatient,,,95,66.5,,76,80,,60.8,percent of total Billed Charges,80% of Total Billed Charges,20.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.21,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,80.75,85,,64.6,percent of total Billed Charges,85% of total Billed Charges,76,80,,60.8,percent of total Billed Charges,80% of total Billed Charges,21.42,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,20.7,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,21.21,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.11,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,21.21,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,76,80,,60.8,percent of total Billed Charges,80% of Total Billed Charges,21.21,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.21,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.7,80.75,
"Myoglobin, Ur LC",140146,CDM,301,RC,83874,HCPCS,Outpatient,,,72,50.4,,57.6,80,,46.08,percent of total Billed Charges,80% of Total Billed Charges,16.24,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.24,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.2,85,,48.96,percent of total Billed Charges,85% of total Billed Charges,57.6,80,,46.08,percent of total Billed Charges,80% of total Billed Charges,13.05,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,16.24,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.56,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,57.6,80,,46.08,percent of total Billed Charges,80% of Total Billed Charges,12.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.92,61.2,
86003 - F002-IgE Milk LC,141170,CDM,301,RC,83880,HCPCS,Outpatient,,,318,222.6,,254.4,80,,203.52,percent of total Billed Charges,80% of Total Billed Charges,42.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,270.3,85,,216.24,percent of total Billed Charges,85% of total Billed Charges,254.4,80,,203.52,percent of total Billed Charges,80% of total Billed Charges,39.65,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,42.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,39.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,43.54,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,39.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,254.4,80,,203.52,percent of total Billed Charges,80% of Total Billed Charges,39.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,39.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,39.26,270.3,
Osmolality LC,140153,CDM,301,RC,83930,HCPCS,Outpatient,,,37,25.9,,29.6,80,,23.68,percent of total Billed Charges,80% of Total Billed Charges,8.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,31.45,85,,25.16,percent of total Billed Charges,85% of total Billed Charges,29.6,80,,23.68,percent of total Billed Charges,80% of total Billed Charges,6.68,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.32,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.49,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,29.6,80,,23.68,percent of total Billed Charges,80% of Total Billed Charges,6.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.61,31.45,
140154 - Osmolality Ur LC,83935,CDM,301,RC,83935,HCPCS,Outpatient,,,38,26.6,,30.4,80,,24.32,percent of total Billed Charges,80% of Total Billed Charges,8.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.82,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,32.3,85,,25.84,percent of total Billed Charges,85% of total Billed Charges,30.4,80,,24.32,percent of total Billed Charges,80% of total Billed Charges,6.89,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.82,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.74,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.82,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,30.4,80,,24.32,percent of total Billed Charges,80% of Total Billed Charges,6.82,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.82,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.82,32.3,
83945 - Oxalate Quant 24Hr Ur LC,140558,CDM,301,RC,83945,HCPCS,Outpatient,,,72,50.4,,57.6,80,,46.08,percent of total Billed Charges,80% of Total Billed Charges,16.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.45,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.2,85,,48.96,percent of total Billed Charges,85% of total Billed Charges,57.6,80,,46.08,percent of total Billed Charges,80% of total Billed Charges,14.59,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,16.19,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.45,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.51,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.45,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,57.6,80,,46.08,percent of total Billed Charges,80% of Total Billed Charges,14.45,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.45,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.45,61.2,
84154 - PSA Free LC,141362,CDM,301,RC,84154,HCPCS,Outpatient,,,102,71.4,,81.6,80,,65.28,percent of total Billed Charges,80% of Total Billed Charges,23.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,86.7,85,,69.36,percent of total Billed Charges,85% of total Billed Charges,81.6,80,,65.28,percent of total Billed Charges,80% of total Billed Charges,18.57,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,23.13,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,18.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.59,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,18.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,81.6,80,,65.28,percent of total Billed Charges,80% of Total Billed Charges,18.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.39,86.7,
84153 - PSA LC,140774,CDM,301,RC,84153,HCPCS,Outpatient,,,102,71.4,,81.6,80,,65.28,percent of total Billed Charges,80% of Total Billed Charges,23.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,86.7,85,,69.36,percent of total Billed Charges,85% of total Billed Charges,81.6,80,,65.28,percent of total Billed Charges,80% of total Billed Charges,18.57,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,23.13,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,18.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.59,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,18.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,81.6,80,,65.28,percent of total Billed Charges,80% of Total Billed Charges,18.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.39,86.7,
140180 - PTH Intact LC,83970,CDM,301,RC,83970,HCPCS,Outpatient,,,256,179.2,,204.8,80,,163.84,percent of total Billed Charges,80% of Total Billed Charges,51.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,41.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,217.6,85,,174.08,percent of total Billed Charges,85% of total Billed Charges,204.8,80,,163.84,percent of total Billed Charges,80% of total Billed Charges,41.69,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,51.9,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,41.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,52.94,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,41.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,204.8,80,,163.84,percent of total Billed Charges,80% of Total Billed Charges,41.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,41.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,41.28,217.6,
82397 - PTHrP (PTH-Related Peptide) LC,141471,CDM,301,RC,82397,HCPCS,Outpatient,,,64,44.8,,51.2,80,,40.96,percent of total Billed Charges,80% of Total Billed Charges,17.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54.4,85,,43.52,percent of total Billed Charges,85% of total Billed Charges,51.2,80,,40.96,percent of total Billed Charges,80% of total Billed Charges,14.26,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,17.77,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.13,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.2,80,,40.96,percent of total Billed Charges,80% of Total Billed Charges,14.12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.12,54.4,
140157 - Phenobarbital LC,80184,CDM,301,RC,80184,HCPCS,Outpatient,,,69,48.3,,55.2,80,,44.16,percent of total Billed Charges,80% of Total Billed Charges,14.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,58.65,85,,46.92,percent of total Billed Charges,85% of total Billed Charges,55.2,80,,44.16,percent of total Billed Charges,80% of total Billed Charges,15.45,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,14.41,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,15.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,15.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,55.2,80,,44.16,percent of total Billed Charges,80% of Total Billed Charges,15.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.41,58.65,
82104 - Phenotype PI LC,141077,CDM,301,RC,82104,HCPCS,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,18.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.46,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,14.6,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,18.18,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.46,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.54,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.46,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,14.46,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.46,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.46,76.5,
80184 - Phenytoin LvL Total,140157,CDM,301,RC,80184,HCPCS,Outpatient,,,69,48.3,,55.2,80,,44.16,percent of total Billed Charges,80% of Total Billed Charges,14.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,58.65,85,,46.92,percent of total Billed Charges,85% of total Billed Charges,55.2,80,,44.16,percent of total Billed Charges,80% of total Billed Charges,15.45,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,14.41,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,15.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,15.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,55.2,80,,44.16,percent of total Billed Charges,80% of Total Billed Charges,15.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.41,58.65,
84100 - Phosphorus Level,140159,CDM,301,RC,84100,HCPCS,Outpatient,,,26,18.2,,20.8,80,,16.64,percent of total Billed Charges,80% of Total Billed Charges,5.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.1,85,,17.68,percent of total Billed Charges,85% of total Billed Charges,20.8,80,,16.64,percent of total Billed Charges,80% of total Billed Charges,4.79,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,5.97,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,4.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.09,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,4.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.8,80,,16.64,percent of total Billed Charges,80% of Total Billed Charges,4.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.74,22.1,
140347 - Porphyrines Qnt 24-Hr Urine LC,84120,CDM,301,RC,84120,HCPCS,Outpatient,,,82,57.4,,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,18.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,69.7,85,,55.76,percent of total Billed Charges,85% of total Billed Charges,65.6,80,,52.48,percent of total Billed Charges,80% of total Billed Charges,14.86,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,18.5,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.87,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,14.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.71,69.7,
84132 - Potassium Level,140163,CDM,301,RC,84132,HCPCS,Outpatient,,,26,18.2,,20.8,80,,16.64,percent of total Billed Charges,80% of Total Billed Charges,5.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.76,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.1,85,,17.68,percent of total Billed Charges,85% of total Billed Charges,20.8,80,,16.64,percent of total Billed Charges,80% of total Billed Charges,4.81,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,5.78,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,4.76,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.9,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,4.76,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.8,80,,16.64,percent of total Billed Charges,80% of Total Billed Charges,4.76,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.76,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.76,22.1,
141195 - Potassium Ur LC,84133,CDM,301,RC,84133,HCPCS,Outpatient,,,24,16.8,,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,5.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.73,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.4,85,,16.32,percent of total Billed Charges,85% of total Billed Charges,19.2,80,,15.36,percent of total Billed Charges,80% of total Billed Charges,4.78,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,5.41,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,4.73,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.52,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,4.73,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,4.73,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.73,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.73,20.4,
141545 - Prealbumin LC,84134,CDM,301,RC,84134,HCPCS,Outpatient,,,81,56.7,,64.8,80,,51.84,percent of total Billed Charges,80% of Total Billed Charges,18.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.59,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.85,85,,55.08,percent of total Billed Charges,85% of total Billed Charges,64.8,80,,51.84,percent of total Billed Charges,80% of total Billed Charges,14.74,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,18.34,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.59,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.71,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.59,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,64.8,80,,51.84,percent of total Billed Charges,80% of Total Billed Charges,14.59,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.59,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.59,68.85,
141402 - Procalcitonin LC,84145,CDM,301,RC,84145,HCPCS,Outpatient,,,123,86.1,,98.4,80,,78.72,percent of total Billed Charges,80% of Total Billed Charges,24.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,104.55,85,,83.64,percent of total Billed Charges,85% of total Billed Charges,98.4,80,,78.72,percent of total Billed Charges,80% of total Billed Charges,27.49,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,24.06,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,27.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.54,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,27.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,98.4,80,,78.72,percent of total Billed Charges,80% of Total Billed Charges,27.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.06,104.55,
140246 - Prolactin LC,84146,CDM,301,RC,84146,HCPCS,Outpatient,,,108,75.6,,86.4,80,,69.12,percent of total Billed Charges,80% of Total Billed Charges,24.37,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,19.38,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.37,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,91.8,85,,73.44,percent of total Billed Charges,85% of total Billed Charges,86.4,80,,69.12,percent of total Billed Charges,80% of total Billed Charges,19.57,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,24.37,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,19.38,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.86,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,19.38,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,86.4,80,,69.12,percent of total Billed Charges,80% of Total Billed Charges,19.38,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.38,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.38,91.8,
Prostate Specific Antigen Screening LC,140264,CDM,301,RC,,,Outpatient,,,102,71.4,,81.6,80,,65.28,percent of total Billed Charges,80% of Total Billed Charges,64.26,63,,51.408,percent of total Billed charges,63% of Total Billed Charges,63.24,62,,50.592,percent of total Billed Charges,62% of total BIlled charges,64.26,63,,51.408,percent of total Billed Charges,63% of total Billed Charges,86.7,85,,69.36,percent of total Billed Charges,85% of total Billed Charges,81.6,80,,65.28,percent of total Billed Charges,80% of total Billed Charges,63.24,62,,50.592,percent of total Billed Charges,62% of total Billed Charges,64.26,63,,51.408,percent of total Billed Charges,63% of total Billed Charges,63.24,62,,50.592,percent of total Billed Charges,62% of total Billed Charges,64.26,63,,51.408,percent of total billed charges,63% of total Billed Charges,63.24,62,,50.592,percent of total Billed Charges,62% of total Billed Charges,81.6,80,,65.28,percent of total Billed Charges,80% of Total Billed Charges,63.24,62,,50.592,percent of total Billed Charges,62% of total Billed Charges,63.24,62,,50.592,percent of total Billed Charges,62% of total Billed Charges,63.24,86.7,
140774 - Prostate-Specific Ag Serum LC,140774,CDM,301,RC,84153,HCPCS,Outpatient,,,102,71.4,,81.6,80,,65.28,percent of total Billed Charges,80% of Total Billed Charges,23.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.13,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,86.7,85,,69.36,percent of total Billed Charges,85% of total Billed Charges,81.6,80,,65.28,percent of total Billed Charges,80% of total Billed Charges,18.57,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,23.13,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,18.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.59,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,18.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,81.6,80,,65.28,percent of total Billed Charges,80% of Total Billed Charges,18.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.39,86.7,
85306 - Protein S Free LC,141068,CDM,301,RC,85306,HCPCS,Outpatient,,,85,59.5,,68,80,,54.4,percent of total Billed Charges,80% of Total Billed Charges,19.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,72.25,85,,57.8,percent of total Billed Charges,85% of total Billed Charges,68,80,,54.4,percent of total Billed Charges,80% of total Billed Charges,15.47,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,19.27,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,15.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.66,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,15.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,68,80,,54.4,percent of total Billed Charges,80% of Total Billed Charges,15.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.32,72.25,
85306 - Protein S Funct LC,141068,CDM,301,RC,85306,HCPCS,Outpatient,,,85,59.5,,68,80,,54.4,percent of total Billed Charges,80% of Total Billed Charges,19.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,72.25,85,,57.8,percent of total Billed Charges,85% of total Billed Charges,68,80,,54.4,percent of total Billed Charges,80% of total Billed Charges,15.47,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,19.27,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,15.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.66,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,15.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,68,80,,54.4,percent of total Billed Charges,80% of Total Billed Charges,15.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.32,72.25,
84155 - Protein Total,140169,CDM,301,RC,84155,HCPCS,Outpatient,,,20,14,,16,80,,12.8,percent of total Billed Charges,80% of Total Billed Charges,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17,85,,13.6,percent of total Billed Charges,85% of total Billed Charges,16,80,,12.8,percent of total Billed Charges,80% of total Billed Charges,3.71,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.61,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16,80,,12.8,percent of total Billed Charges,80% of Total Billed Charges,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.67,17,
84155 - Protein Total LC,140169,CDM,301,RC,84155,HCPCS,Outpatient,,,20,14,,16,80,,12.8,percent of total Billed Charges,80% of Total Billed Charges,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17,85,,13.6,percent of total Billed Charges,85% of total Billed Charges,16,80,,12.8,percent of total Billed Charges,80% of total Billed Charges,3.71,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.61,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16,80,,12.8,percent of total Billed Charges,80% of Total Billed Charges,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.67,17,
84156 - Protein Total Ur LC,141199,CDM,301,RC,84156,HCPCS,Outpatient,,,10,7,,8,80,,6.4,percent of total Billed Charges,80% of Total Billed Charges,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.5,85,,6.8,percent of total Billed Charges,85% of total Billed Charges,8,80,,6.4,percent of total Billed Charges,80% of total Billed Charges,3.71,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.61,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8,80,,6.4,percent of total Billed Charges,80% of Total Billed Charges,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.67,8.5,
84156 - Protein Total Ur LC,141199,CDM,301,RC,84156,HCPCS,Outpatient,,,10,7,,8,80,,6.4,percent of total Billed Charges,80% of Total Billed Charges,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.5,85,,6.8,percent of total Billed Charges,85% of total Billed Charges,8,80,,6.4,percent of total Billed Charges,80% of total Billed Charges,3.71,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.61,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8,80,,6.4,percent of total Billed Charges,80% of Total Billed Charges,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.67,8.5,
Protein Total Ur LC,141199,CDM,301,RC,84156,HCPCS,Outpatient,,,10,7,,8,80,,6.4,percent of total Billed Charges,80% of Total Billed Charges,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.5,85,,6.8,percent of total Billed Charges,85% of total Billed Charges,8,80,,6.4,percent of total Billed Charges,80% of total Billed Charges,3.71,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.61,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8,80,,6.4,percent of total Billed Charges,80% of Total Billed Charges,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.67,8.5,
84156 - Protein Total Qn 24-Hr Ur LC,141199,CDM,301,RC,84156,HCPCS,Outpatient,,,10,7,,8,80,,6.4,percent of total Billed Charges,80% of Total Billed Charges,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.5,85,,6.8,percent of total Billed Charges,85% of total Billed Charges,8,80,,6.4,percent of total Billed Charges,80% of total Billed Charges,3.71,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.61,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8,80,,6.4,percent of total Billed Charges,80% of Total Billed Charges,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.67,8.5,
141199 - ProteinTotalRandom Ur LC,84156,CDM,301,RC,84156,HCPCS,Outpatient,,,10,7,,8,80,,6.4,percent of total Billed Charges,80% of Total Billed Charges,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.61,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.5,85,,6.8,percent of total Billed Charges,85% of total Billed Charges,8,80,,6.4,percent of total Billed Charges,80% of total Billed Charges,3.71,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.61,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8,80,,6.4,percent of total Billed Charges,80% of Total Billed Charges,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.67,8.5,
80069 - Renal Function Panel,140964,CDM,301,RC,80069,HCPCS,Outpatient,,,48,33.6,,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,10.92,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.68,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.92,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.8,85,,32.64,percent of total Billed Charges,85% of total Billed Charges,38.4,80,,30.72,percent of total Billed Charges,80% of total Billed Charges,8.77,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.92,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.68,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.14,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.68,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,8.68,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.68,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.68,40.8,
140182 - Renin Activity LC,84244,CDM,301,RC,84244,HCPCS,Outpatient,,,122,85.4,,97.6,80,,78.08,percent of total Billed Charges,80% of Total Billed Charges,27.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,103.7,85,,82.96,percent of total Billed Charges,85% of total Billed Charges,97.6,80,,78.08,percent of total Billed Charges,80% of total Billed Charges,22.21,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,27.66,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,21.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28.21,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,21.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,97.6,80,,78.08,percent of total Billed Charges,80% of Total Billed Charges,21.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.99,103.7,
84244 - Renin Activity LC,140182,CDM,301,RC,84244,HCPCS,Outpatient,,,122,85.4,,97.6,80,,78.08,percent of total Billed Charges,80% of Total Billed Charges,27.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,103.7,85,,82.96,percent of total Billed Charges,85% of total Billed Charges,97.6,80,,78.08,percent of total Billed Charges,80% of total Billed Charges,22.21,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,27.66,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,21.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28.21,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,21.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,97.6,80,,78.08,percent of total Billed Charges,80% of Total Billed Charges,21.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.99,103.7,
80329 - Salicylate Level,140190,CDM,301,RC,80329,HCPCS,Outpatient,,,323,226.1,,258.4,80,,206.72,percent of total Billed Charges,80% of Total Billed Charges,25.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,200.26,62,,160.208,percent of total Billed Charges,62% of total BIlled charges,25.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,274.55,85,,219.64,percent of total Billed Charges,85% of total Billed Charges,258.4,80,,206.72,percent of total Billed Charges,80% of total Billed Charges,200.26,62,,160.208,percent of total Billed Charges,62% of total Billed Charges,25.45,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,200.26,62,,160.208,percent of total Billed Charges,62% of total Billed Charges,25.96,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,200.26,62,,160.208,percent of total Billed Charges,62% of total Billed Charges,258.4,80,,206.72,percent of total Billed Charges,80% of Total Billed Charges,200.26,62,,160.208,percent of total Billed Charges,62% of total Billed Charges,200.26,62,,160.208,percent of total Billed Charges,62% of total Billed Charges,25.45,274.55,
140309 - Sex Horm Binding Glob LC,84270,CDM,301,RC,84270,HCPCS,Outpatient,,,135,94.5,,108,80,,86.4,percent of total Billed Charges,80% of Total Billed Charges,27.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.73,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,114.75,85,,91.8,percent of total Billed Charges,85% of total Billed Charges,108,80,,86.4,percent of total Billed Charges,80% of total Billed Charges,21.95,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,27.32,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,21.73,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.87,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,21.73,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,108,80,,86.4,percent of total Billed Charges,80% of Total Billed Charges,21.73,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.73,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.73,114.75,
140861 - Sirolimus (Rapamune) Bld LC,80195,CDM,301,RC,80195,HCPCS,Outpatient,,,76,53.2,,60.8,80,,48.64,percent of total Billed Charges,80% of Total Billed Charges,17.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.73,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,64.6,85,,51.68,percent of total Billed Charges,85% of total Billed Charges,60.8,80,,48.64,percent of total Billed Charges,80% of total Billed Charges,13.87,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,17.25,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.73,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.6,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.73,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60.8,80,,48.64,percent of total Billed Charges,80% of Total Billed Charges,13.73,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.73,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.73,64.6,
84300 - Sodium 24Hr Ur LC,141196,CDM,301,RC,84300,HCPCS,Outpatient,,,24,16.8,,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,4.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.4,85,,16.32,percent of total Billed Charges,85% of total Billed Charges,19.2,80,,15.36,percent of total Billed Charges,80% of total Billed Charges,5.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.44,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,5.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.35,20.4,
84300 - Sodium Ur LC,141196,CDM,301,RC,84300,HCPCS,Outpatient,,,24,16.8,,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,4.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.4,85,,16.32,percent of total Billed Charges,85% of total Billed Charges,19.2,80,,15.36,percent of total Billed Charges,80% of total Billed Charges,5.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.44,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,5.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.35,20.4,
Soluble Transferrin Receptor LC - 143305,140789,CDM,301,RC,84238,HCPCS,Outpatient,,,165,115.5,,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,45.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,36.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,45.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,140.25,85,,112.2,percent of total Billed Charges,85% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of total Billed Charges,36.94,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,45.98,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,36.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,46.9,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,36.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,36.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,36.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,36.57,140.25,
T001-IgE Maple/Box Elder LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
T003-IgE Common Silver Birch LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
T007-IgE Oak White LC,141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
84479 - T3 Uptake LC,140761,CDM,301,RC,84479,HCPCS,Outpatient,,,36,25.2,,28.8,80,,23.04,percent of total Billed Charges,80% of Total Billed Charges,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,30.6,85,,24.48,percent of total Billed Charges,85% of total Billed Charges,28.8,80,,23.04,percent of total Billed Charges,80% of total Billed Charges,6.53,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.14,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.3,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28.8,80,,23.04,percent of total Billed Charges,80% of Total Billed Charges,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.47,30.6,
84436 - T4 Thyroxine LC,140203,CDM,301,RC,84436,HCPCS,Outpatient,,,38,26.6,,30.4,80,,24.32,percent of total Billed Charges,80% of Total Billed Charges,8.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.87,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,32.3,85,,25.84,percent of total Billed Charges,85% of total Billed Charges,30.4,80,,24.32,percent of total Billed Charges,80% of total Billed Charges,6.94,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.65,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.87,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.82,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.87,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,30.4,80,,24.32,percent of total Billed Charges,80% of Total Billed Charges,6.87,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.87,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.87,32.3,
84443 - TSH LC,140825,CDM,301,RC,84443,HCPCS,Outpatient,,,93,65.1,,74.4,80,,59.52,percent of total Billed Charges,80% of Total Billed Charges,21.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,79.05,85,,63.24,percent of total Billed Charges,85% of total Billed Charges,74.4,80,,59.52,percent of total Billed Charges,80% of total Billed Charges,16.97,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,21.12,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.54,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,74.4,80,,59.52,percent of total Billed Charges,80% of Total Billed Charges,16.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.8,79.05,
84443 - Thyroid Stimulating Hormone,140825,CDM,301,RC,84443,HCPCS,Outpatient,,,93,65.1,,74.4,80,,59.52,percent of total Billed Charges,80% of Total Billed Charges,21.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,79.05,85,,63.24,percent of total Billed Charges,85% of total Billed Charges,74.4,80,,59.52,percent of total Billed Charges,80% of total Billed Charges,16.97,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,21.12,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.54,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,74.4,80,,59.52,percent of total Billed Charges,80% of Total Billed Charges,16.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.8,79.05,
140859 - Tacrolimus (FK506) Bld LC,80197,CDM,301,RC,80197,HCPCS,Outpatient,,,76,53.2,,60.8,80,,48.64,percent of total Billed Charges,80% of Total Billed Charges,17.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.73,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.25,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,64.6,85,,51.68,percent of total Billed Charges,85% of total Billed Charges,60.8,80,,48.64,percent of total Billed Charges,80% of total Billed Charges,13.87,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,17.25,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.73,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.6,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.73,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60.8,80,,48.64,percent of total Billed Charges,80% of Total Billed Charges,13.73,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.73,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.73,64.6,
140206 - Testosterone LC,84403,CDM,301,RC,84403,HCPCS,Outpatient,,,143,100.1,,114.4,80,,91.52,percent of total Billed Charges,80% of Total Billed Charges,32.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,32.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,121.55,85,,97.24,percent of total Billed Charges,85% of total Billed Charges,114.4,80,,91.52,percent of total Billed Charges,80% of total Billed Charges,26.07,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,32.47,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,25.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,33.12,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,25.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,114.4,80,,91.52,percent of total Billed Charges,80% of Total Billed Charges,25.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.81,121.55,
84403 - Testosterone LC,140206,CDM,301,RC,84403,HCPCS,Outpatient,,,143,100.1,,114.4,80,,91.52,percent of total Billed Charges,80% of Total Billed Charges,32.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,32.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,121.55,85,,97.24,percent of total Billed Charges,85% of total Billed Charges,114.4,80,,91.52,percent of total Billed Charges,80% of total Billed Charges,26.07,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,32.47,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,25.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,33.12,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,25.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,114.4,80,,91.52,percent of total Billed Charges,80% of Total Billed Charges,25.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.81,121.55,
"Testosterone,Free+Weakly Bound LC",141286,CDM,301,RC,84410,HCPCS,Outpatient,,,285,199.5,,228,80,,182.4,percent of total Billed Charges,80% of Total Billed Charges,179.55,63,,143.64,percent of total Billed charges,63% of Total Billed Charges,51.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,179.55,63,,143.64,percent of total Billed Charges,63% of total Billed Charges,242.25,85,,193.8,percent of total Billed Charges,85% of total Billed Charges,228,80,,182.4,percent of total Billed Charges,80% of total Billed Charges,51.79,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,179.55,63,,143.64,percent of total Billed Charges,63% of total Billed Charges,51.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,179.55,63,,143.64,percent of total billed charges,63% of total Billed Charges,51.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,228,80,,182.4,percent of total Billed Charges,80% of Total Billed Charges,51.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.28,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.28,242.25,
Thiopurine Methyltransferase LC,141343,CDM,301,RC,84433,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.74,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.74,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,22.39,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,17.74,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,22.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.09,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,22.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.74,85,
84443 - Thyroid Stimulating Hormone,140825,CDM,301,RC,84443,HCPCS,Outpatient,,,93,65.1,,74.4,80,,59.52,percent of total Billed Charges,80% of Total Billed Charges,21.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,79.05,85,,63.24,percent of total Billed Charges,85% of total Billed Charges,74.4,80,,59.52,percent of total Billed Charges,80% of total Billed Charges,16.97,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,21.12,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.54,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,74.4,80,,59.52,percent of total Billed Charges,80% of Total Billed Charges,16.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.8,79.05,
140667 - Thyroxine (T4) Free Direct LC,84439,CDM,301,RC,84439,HCPCS,Outpatient,,,50,35,,40,80,,32,percent of total Billed Charges,80% of Total Billed Charges,11.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.34,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.5,85,,34,percent of total Billed Charges,85% of total Billed Charges,40,80,,32,percent of total Billed Charges,80% of total Billed Charges,9.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,11.34,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,9.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.57,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,9.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,40,80,,32,percent of total Billed Charges,80% of Total Billed Charges,9.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.02,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.02,42.5,
140203 - Thyroxine (T4) LC,84436,CDM,301,RC,84436,HCPCS,Outpatient,,,38,26.6,,30.4,80,,24.32,percent of total Billed Charges,80% of Total Billed Charges,8.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.87,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,32.3,85,,25.84,percent of total Billed Charges,85% of total Billed Charges,30.4,80,,24.32,percent of total Billed Charges,80% of total Billed Charges,6.94,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.65,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.87,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.82,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.87,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,30.4,80,,24.32,percent of total Billed Charges,80% of Total Billed Charges,6.87,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.87,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.87,32.3,
140209 - Transferrin LC,84466,CDM,301,RC,84466,HCPCS,Outpatient,,,71,49.7,,56.8,80,,45.44,percent of total Billed Charges,80% of Total Billed Charges,16.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.76,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,60.35,85,,48.28,percent of total Billed Charges,85% of total Billed Charges,56.8,80,,45.44,percent of total Billed Charges,80% of total Billed Charges,12.89,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,16.06,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.76,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.76,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,56.8,80,,45.44,percent of total Billed Charges,80% of Total Billed Charges,12.76,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.76,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.76,60.35,
84478 - Triglycerides,140210,CDM,301,RC,84478,HCPCS,Outpatient,,,32,22.4,,25.6,80,,20.48,percent of total Billed Charges,80% of Total Billed Charges,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,27.2,85,,21.76,percent of total Billed Charges,85% of total Billed Charges,25.6,80,,20.48,percent of total Billed Charges,80% of total Billed Charges,5.8,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.48,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.6,80,,20.48,percent of total Billed Charges,80% of Total Billed Charges,5.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.74,27.2,
140202 - Triiodothyronine (T3) LC,84480,CDM,301,RC,84480,HCPCS,Outpatient,,,79,55.3,,63.2,80,,50.56,percent of total Billed Charges,80% of Total Billed Charges,16.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,67.15,85,,53.72,percent of total Billed Charges,85% of total Billed Charges,63.2,80,,50.56,percent of total Billed Charges,80% of total Billed Charges,14.32,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,16.03,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.35,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,63.2,80,,50.56,percent of total Billed Charges,80% of Total Billed Charges,14.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.18,67.15,
140539 - Triiodothyronine (T3) Free LC,84481,CDM,301,RC,84481,HCPCS,Outpatient,,,94,65.8,,75.2,80,,60.16,percent of total Billed Charges,80% of Total Billed Charges,21.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,79.9,85,,63.92,percent of total Billed Charges,85% of total Billed Charges,75.2,80,,60.16,percent of total Billed Charges,80% of total Billed Charges,17.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,21.3,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.73,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,75.2,80,,60.16,percent of total Billed Charges,80% of Total Billed Charges,16.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.94,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.94,79.9,
84550 - Uric Acid,140211,CDM,301,RC,84550,HCPCS,Outpatient,,,25,17.5,,20,80,,16,percent of total Billed Charges,80% of Total Billed Charges,5.68,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.68,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.25,85,,17,percent of total Billed Charges,85% of total Billed Charges,20,80,,16,percent of total Billed Charges,80% of total Billed Charges,4.57,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,5.68,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,4.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.79,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,4.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20,80,,16,percent of total Billed Charges,80% of Total Billed Charges,4.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.52,21.25,
140413 - Uric Acid 24h Ur LC,84560,CDM,301,RC,84560,HCPCS,Outpatient,,,26,18.2,,20.8,80,,16.64,percent of total Billed Charges,80% of Total Billed Charges,5.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.1,85,,17.68,percent of total Billed Charges,85% of total Billed Charges,20.8,80,,16.64,percent of total Billed Charges,80% of total Billed Charges,5.13,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,5.98,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.1,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.8,80,,16.64,percent of total Billed Charges,80% of Total Billed Charges,5.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.08,22.1,
140079 - Valproic Acid (Depakote)(R)S LC,80164,CDM,301,RC,80164,HCPCS,Outpatient,,,75,52.5,,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,14.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.54,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,63.75,85,,51,percent of total Billed Charges,85% of total Billed Charges,60,80,,48,percent of total Billed Charges,80% of total Billed Charges,13.68,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,14.27,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.54,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.56,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.54,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,13.54,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.54,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.54,63.75,
80202 - Vancomycin LvL,140959,CDM,301,RC,80202,HCPCS,Outpatient,,,75,52.5,,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,14.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.54,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,63.75,85,,51,percent of total Billed Charges,85% of total Billed Charges,60,80,,48,percent of total Billed Charges,80% of total Billed Charges,13.68,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,14.27,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.54,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.56,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.54,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,13.54,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.54,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.54,63.75,
80202 - Vancomycin Peak LvL,140959,CDM,301,RC,80202,HCPCS,Outpatient,,,75,52.5,,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,14.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.54,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,63.75,85,,51,percent of total Billed Charges,85% of total Billed Charges,60,80,,48,percent of total Billed Charges,80% of total Billed Charges,13.68,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,14.27,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.54,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.56,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.54,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,13.54,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.54,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.54,63.75,
80202 - Vancomycin Trough LvL,140959,CDM,301,RC,80202,HCPCS,Outpatient,,,75,52.5,,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,14.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.54,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,63.75,85,,51,percent of total Billed Charges,85% of total Billed Charges,60,80,,48,percent of total Billed Charges,80% of total Billed Charges,13.68,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,14.27,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.54,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.56,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.54,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,13.54,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.54,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.54,63.75,
140249 - Vitamin A LC,84590,CDM,301,RC,84590,HCPCS,Outpatient,,,64,44.8,,51.2,80,,40.96,percent of total Billed Charges,80% of Total Billed Charges,14.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54.4,85,,43.52,percent of total Billed Charges,85% of total Billed Charges,51.2,80,,40.96,percent of total Billed Charges,80% of total Billed Charges,11.73,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,14.58,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,11.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.87,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,11.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.2,80,,40.96,percent of total Billed Charges,80% of Total Billed Charges,11.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.61,54.4,
140220 - Vitamin B12 LC,82607,CDM,301,RC,82607,HCPCS,Outpatient,,,94,65.8,,75.2,80,,60.16,percent of total Billed Charges,80% of Total Billed Charges,18.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,79.9,85,,63.92,percent of total Billed Charges,85% of total Billed Charges,75.2,80,,60.16,percent of total Billed Charges,80% of total Billed Charges,15.23,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,18.95,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,15.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.33,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,15.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,75.2,80,,60.16,percent of total Billed Charges,80% of Total Billed Charges,15.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,79.9,
82607 - Vitamin B12 LC,140220,CDM,301,RC,82607,HCPCS,Outpatient,,,94,65.8,,75.2,80,,60.16,percent of total Billed Charges,80% of Total Billed Charges,18.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,79.9,85,,63.92,percent of total Billed Charges,85% of total Billed Charges,75.2,80,,60.16,percent of total Billed Charges,80% of total Billed Charges,15.23,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,18.95,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,15.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.33,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,15.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,75.2,80,,60.16,percent of total Billed Charges,80% of Total Billed Charges,15.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,79.9,
140668 - Vitamin B6 LC,84207,CDM,301,RC,84207,HCPCS,Outpatient,,,156,109.2,,124.8,80,,99.84,percent of total Billed Charges,80% of Total Billed Charges,35.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,35.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,132.6,85,,106.08,percent of total Billed Charges,85% of total Billed Charges,124.8,80,,99.84,percent of total Billed Charges,80% of total Billed Charges,28.38,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,35.33,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,28.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,36.04,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,28.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,124.8,80,,99.84,percent of total Billed Charges,80% of Total Billed Charges,28.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28.1,132.6,
140619 - Vitamin D 25-Hydroxy LC,82306,CDM,301,RC,82306,HCPCS,Outpatient,,,165,115.5,,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,37.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,37.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,140.25,85,,112.2,percent of total Billed Charges,85% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of total Billed Charges,29.9,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,37.22,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,29.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,37.96,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,29.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,29.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,29.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,29.6,140.25,
140900 - Vitamin E LC,84446,CDM,301,RC,84446,HCPCS,Outpatient,,,79,55.3,,63.2,80,,50.56,percent of total Billed Charges,80% of Total Billed Charges,17.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,67.15,85,,53.72,percent of total Billed Charges,85% of total Billed Charges,63.2,80,,50.56,percent of total Billed Charges,80% of total Billed Charges,14.32,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,17.83,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.19,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,63.2,80,,50.56,percent of total Billed Charges,80% of Total Billed Charges,14.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.18,67.15,
"W002 - IgE Ragweed, Western LC",141133,CDM,301,RC,86003,HCPCS,Outpatient,,,33,23.1,,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.05,85,,22.44,percent of total Billed Charges,85% of total Billed Charges,26.4,80,,21.12,percent of total Billed Charges,80% of total Billed Charges,5.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.4,80,,21.12,percent of total Billed Charges,80% of Total Billed Charges,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.22,28.05,
84630 - Zinc WhlBld LC,140511,CDM,301,RC,84630,HCPCS,Outpatient,,,63,44.1,,50.4,80,,40.32,percent of total Billed Charges,80% of Total Billed Charges,14.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,53.55,85,,42.84,percent of total Billed Charges,85% of total Billed Charges,50.4,80,,40.32,percent of total Billed Charges,80% of total Billed Charges,11.5,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,14.32,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,11.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.61,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,11.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,50.4,80,,40.32,percent of total Billed Charges,80% of Total Billed Charges,11.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.39,53.55,
84630 - Zinc Whole Blood LC,140511,CDM,301,RC,84630,HCPCS,Outpatient,,,63,44.1,,50.4,80,,40.32,percent of total Billed Charges,80% of Total Billed Charges,14.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.32,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,53.55,85,,42.84,percent of total Billed Charges,85% of total Billed Charges,50.4,80,,40.32,percent of total Billed Charges,80% of total Billed Charges,11.5,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,14.32,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,11.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.61,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,11.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,50.4,80,,40.32,percent of total Billed Charges,80% of Total Billed Charges,11.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.39,53.55,
84484 - hs Troponin-I,140647,CDM,301,RC,84484,HCPCS,Outpatient,,,46,32.2,,36.8,80,,29.44,percent of total Billed Charges,80% of Total Billed Charges,12.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.1,85,,31.28,percent of total Billed Charges,85% of total Billed Charges,36.8,80,,29.44,percent of total Billed Charges,80% of total Billed Charges,12.59,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,12.38,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.63,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,36.8,80,,29.44,percent of total Billed Charges,80% of Total Billed Charges,12.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.38,39.1,
"pH, Stool LC",141494,CDM,301,RC,83986,HCPCS,Outpatient,,,17,11.9,,13.6,80,,10.88,percent of total Billed Charges,80% of Total Billed Charges,4.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.45,85,,11.56,percent of total Billed Charges,85% of total Billed Charges,13.6,80,,10.88,percent of total Billed Charges,80% of total Billed Charges,3.62,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.5,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,3.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.59,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,3.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.6,80,,10.88,percent of total Billed Charges,80% of Total Billed Charges,3.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.58,14.45,
21931 - EXC tumor soft tissue of back or flank subcutaneous; 3 cm or greater,521931,CDM,301,RC,21931,HCPCS,Outpatient,,,2500,1750,,2000,80,,1600,percent of total Billed Charges,80% of Total Billed Charges,1575,63,,1260,percent of total Billed charges,63% of Total Billed Charges,1550,62,,1240,percent of total Billed Charges,62% of total BIlled charges,1575,63,,1260,percent of total Billed Charges,63% of total Billed Charges,2125,85,,1700,percent of total Billed Charges,85% of total Billed Charges,2000,80,,1600,percent of total Billed Charges,80% of total Billed Charges,1550,62,,1240,percent of total Billed Charges,62% of total Billed Charges,1575,63,,1260,percent of total Billed Charges,63% of total Billed Charges,1550,62,,1240,percent of total Billed Charges,62% of total Billed Charges,1575,63,,1260,percent of total billed charges,63% of total Billed Charges,1550,62,,1240,percent of total Billed Charges,62% of total Billed Charges,2000,80,,1600,percent of total Billed Charges,80% of Total Billed Charges,1550,62,,1240,percent of total Billed Charges,62% of total Billed Charges,1550,62,,1240,percent of total Billed Charges,62% of total Billed Charges,1550,2125,
Topiramate (Topamax) LC,141493,CDM,301,RC,80201,HCPCS,Outpatient,,,54,37.8,,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,14.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.9,85,,36.72,percent of total Billed Charges,85% of total Billed Charges,43.2,80,,34.56,percent of total Billed Charges,80% of total Billed Charges,12.04,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,14.99,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,11.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.29,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,11.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,11.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.92,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.92,45.9,
.ENA+ Abs 160014 LC,140369,CDM,302,RC,86235,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,85,
86317-Pneumococcal IM,140874,CDM,302,RC,86317,HCPCS,Outpatient,,,75,52.5,,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,15.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,63.75,85,,51,percent of total Billed Charges,85% of total Billed Charges,60,80,,48,percent of total Billed Charges,80% of total Billed Charges,15.14,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.09,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.39,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,14.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.99,63.75,
86671-Saccharomyces cerevisiae Profile LC,141431,CDM,302,RC,86671,HCPCS,Outpatient,,,56,39.2,,44.8,80,,35.84,percent of total Billed Charges,80% of Total Billed Charges,15.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.6,85,,38.08,percent of total Billed Charges,85% of total Billed Charges,44.8,80,,35.84,percent of total Billed Charges,80% of total Billed Charges,12.37,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.42,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.73,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,44.8,80,,35.84,percent of total Billed Charges,80% of Total Billed Charges,12.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.25,47.6,
Laboratory services,140352,CDM,302,RC,86901,HCPCS,Outpatient,,,17,11.9,,13.6,80,,10.88,percent of total Billed Charges,80% of Total Billed Charges,14.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,2.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.45,85,,11.56,percent of total Billed Charges,85% of total Billed Charges,13.6,80,,10.88,percent of total Billed Charges,80% of total Billed Charges,3.02,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,14.51,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,2.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.8,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,2.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.6,80,,10.88,percent of total Billed Charges,80% of Total Billed Charges,2.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.99,14.8,
86900 - ABO,140351,CDM,302,RC,86900,HCPCS,Outpatient,,,17,11.9,,13.6,80,,10.88,percent of total Billed Charges,80% of Total Billed Charges,3.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,2.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.45,85,,11.56,percent of total Billed Charges,85% of total Billed Charges,13.6,80,,10.88,percent of total Billed Charges,80% of total Billed Charges,3.02,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,3.75,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,2.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.83,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,2.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.6,80,,10.88,percent of total Billed Charges,80% of Total Billed Charges,2.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.99,14.45,
86900 - ABO,140351,CDM,302,RC,86900,HCPCS,Outpatient,,,17,11.9,,13.6,80,,10.88,percent of total Billed Charges,80% of Total Billed Charges,3.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,2.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.45,85,,11.56,percent of total Billed Charges,85% of total Billed Charges,13.6,80,,10.88,percent of total Billed Charges,80% of total Billed Charges,3.02,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,3.75,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,2.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.83,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,2.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.6,80,,10.88,percent of total Billed Charges,80% of Total Billed Charges,2.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.99,14.45,
Laboratory services,14023,CDM,302,RC,86850,HCPCS,Outpatient,,,44,30.8,,35.2,80,,28.16,percent of total Billed Charges,80% of Total Billed Charges,15.23,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.23,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,37.4,85,,29.92,percent of total Billed Charges,85% of total Billed Charges,35.2,80,,28.16,percent of total Billed Charges,80% of total Billed Charges,9.87,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.23,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,9.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.53,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,9.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,35.2,80,,28.16,percent of total Billed Charges,80% of Total Billed Charges,9.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.77,37.4,
86850 - Antibody Screen Gel,140023,CDM,302,RC,86850,HCPCS,Outpatient,,,44,30.8,,35.2,80,,28.16,percent of total Billed Charges,80% of Total Billed Charges,15.23,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.23,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,37.4,85,,29.92,percent of total Billed Charges,85% of total Billed Charges,35.2,80,,28.16,percent of total Billed Charges,80% of total Billed Charges,9.87,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.23,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,9.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.53,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,9.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,35.2,80,,28.16,percent of total Billed Charges,80% of Total Billed Charges,9.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.77,37.4,
86870 - Bill Only ABID Panel,140022,CDM,302,RC,86870,HCPCS,Outpatient,,,305,213.5,,244,80,,195.2,percent of total Billed Charges,80% of Total Billed Charges,6.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,189.1,62,,151.28,percent of total Billed Charges,62% of total BIlled charges,6.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,259.25,85,,207.4,percent of total Billed Charges,85% of total Billed Charges,244,80,,195.2,percent of total Billed Charges,80% of total Billed Charges,189.1,62,,151.28,percent of total Billed Charges,62% of total Billed Charges,6.12,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,189.1,62,,151.28,percent of total Billed Charges,62% of total Billed Charges,6.24,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,189.1,62,,151.28,percent of total Billed Charges,62% of total Billed Charges,244,80,,195.2,percent of total Billed Charges,80% of Total Billed Charges,189.1,62,,151.28,percent of total Billed Charges,62% of total Billed Charges,189.1,62,,151.28,percent of total Billed Charges,62% of total Billed Charges,6.12,259.25,
86905 - Bill Only Antigen Typing,140988,CDM,302,RC,86905,HCPCS,Outpatient,,,21,14.7,,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,4.81,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.81,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.85,85,,14.28,percent of total Billed Charges,85% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of total Billed Charges,3.87,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.81,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,3.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.91,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,3.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,3.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.83,17.85,
86922 - XM Gel Interp  Compatible,140223,CDM,302,RC,86922,HCPCS,Outpatient,,,270,189,,216,80,,172.8,percent of total Billed Charges,80% of Total Billed Charges,170.1,63,,136.08,percent of total Billed charges,63% of Total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total BIlled charges,170.1,63,,136.08,percent of total Billed Charges,63% of total Billed Charges,229.5,85,,183.6,percent of total Billed Charges,85% of total Billed Charges,216,80,,172.8,percent of total Billed Charges,80% of total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total Billed Charges,170.1,63,,136.08,percent of total Billed Charges,63% of total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total Billed Charges,170.1,63,,136.08,percent of total billed charges,63% of total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total Billed Charges,216,80,,172.8,percent of total Billed Charges,80% of Total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total Billed Charges,167.4,229.5,
86880 - DAT Poly Gel,140055,CDM,302,RC,86880,HCPCS,Outpatient,,,30,21,,24,80,,19.2,percent of total Billed Charges,80% of Total Billed Charges,6.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.5,85,,20.4,percent of total Billed Charges,85% of total Billed Charges,24,80,,19.2,percent of total Billed Charges,80% of total Billed Charges,5.44,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.75,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.89,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24,80,,19.2,percent of total Billed Charges,80% of Total Billed Charges,5.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.39,25.5,
86922 - XM Gel Interp  Incompatible,140223,CDM,302,RC,86922,HCPCS,Outpatient,,,270,189,,216,80,,172.8,percent of total Billed Charges,80% of Total Billed Charges,170.1,63,,136.08,percent of total Billed charges,63% of Total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total BIlled charges,170.1,63,,136.08,percent of total Billed Charges,63% of total Billed Charges,229.5,85,,183.6,percent of total Billed Charges,85% of total Billed Charges,216,80,,172.8,percent of total Billed Charges,80% of total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total Billed Charges,170.1,63,,136.08,percent of total Billed Charges,63% of total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total Billed Charges,170.1,63,,136.08,percent of total billed charges,63% of total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total Billed Charges,216,80,,172.8,percent of total Billed Charges,80% of Total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total Billed Charges,167.4,229.5,
86922 - XM Gel Interp  Least Incompatible,140223,CDM,302,RC,86922,HCPCS,Outpatient,,,270,189,,216,80,,172.8,percent of total Billed Charges,80% of Total Billed Charges,170.1,63,,136.08,percent of total Billed charges,63% of Total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total BIlled charges,170.1,63,,136.08,percent of total Billed Charges,63% of total Billed Charges,229.5,85,,183.6,percent of total Billed Charges,85% of total Billed Charges,216,80,,172.8,percent of total Billed Charges,80% of total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total Billed Charges,170.1,63,,136.08,percent of total Billed Charges,63% of total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total Billed Charges,170.1,63,,136.08,percent of total billed charges,63% of total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total Billed Charges,216,80,,172.8,percent of total Billed Charges,80% of Total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total Billed Charges,167.4,62,,133.92,percent of total Billed Charges,62% of total Billed Charges,167.4,229.5,
86870 - REF Antibody ID,140022,CDM,302,RC,86870,HCPCS,Outpatient,,,305,213.5,,244,80,,195.2,percent of total Billed Charges,80% of Total Billed Charges,6.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,189.1,62,,151.28,percent of total Billed Charges,62% of total BIlled charges,6.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,259.25,85,,207.4,percent of total Billed Charges,85% of total Billed Charges,244,80,,195.2,percent of total Billed Charges,80% of total Billed Charges,189.1,62,,151.28,percent of total Billed Charges,62% of total Billed Charges,6.12,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,189.1,62,,151.28,percent of total Billed Charges,62% of total Billed Charges,6.24,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,189.1,62,,151.28,percent of total Billed Charges,62% of total Billed Charges,244,80,,195.2,percent of total Billed Charges,80% of Total Billed Charges,189.1,62,,151.28,percent of total Billed Charges,62% of total Billed Charges,189.1,62,,151.28,percent of total Billed Charges,62% of total Billed Charges,6.12,259.25,
86905 - REF Antigen Type,140988,CDM,302,RC,86905,HCPCS,Outpatient,,,21,14.7,,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,4.81,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.81,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.85,85,,14.28,percent of total Billed Charges,85% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of total Billed Charges,3.87,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.81,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,3.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.91,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,3.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,3.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.83,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.83,17.85,
.ENA+ Abs 160014 LC,140021,CDM,302,RC,86225,HCPCS,Outpatient,,,76,53.2,,60.8,80,,48.64,percent of total Billed Charges,80% of Total Billed Charges,17.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,64.6,85,,51.68,percent of total Billed Charges,85% of total Billed Charges,60.8,80,,48.64,percent of total Billed Charges,80% of total Billed Charges,13.88,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,17.28,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.63,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60.8,80,,48.64,percent of total Billed Charges,80% of Total Billed Charges,13.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.74,64.6,
140575 - .Immunofixation Elect 001686 LC,86334,CDM,302,RC,86334,HCPCS,Outpatient,,,124,86.8,,99.2,80,,79.36,percent of total Billed Charges,80% of Total Billed Charges,28.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.34,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,105.4,85,,84.32,percent of total Billed Charges,85% of total Billed Charges,99.2,80,,79.36,percent of total Billed Charges,80% of total Billed Charges,22.56,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,28.09,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,22.34,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28.65,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,22.34,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,99.2,80,,79.36,percent of total Billed Charges,80% of Total Billed Charges,22.34,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.34,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.34,105.4,
140454 - .RPR Qn 006464 LC,86593,CDM,302,RC,86593,HCPCS,Outpatient,,,24,16.8,,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,15.12,63,,12.096,percent of total Billed charges,63% of Total Billed Charges,4.4,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.12,63,,12.096,percent of total Billed Charges,63% of total Billed Charges,20.4,85,,16.32,percent of total Billed Charges,85% of total Billed Charges,19.2,80,,15.36,percent of total Billed Charges,80% of total Billed Charges,4.44,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.12,63,,12.096,percent of total Billed Charges,63% of total Billed Charges,4.4,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.12,63,,12.096,percent of total billed charges,63% of total Billed Charges,4.4,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,4.4,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.4,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.4,20.4,
86038 - ANA w/Reflex if Positive LC,140020,CDM,302,RC,86038,HCPCS,Outpatient,,,67,46.9,,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,15.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.95,85,,45.56,percent of total Billed Charges,85% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of total Billed Charges,12.21,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.2,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,12.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.09,56.95,
86038 - ANA w/Rflx LC,140020,CDM,302,RC,86038,HCPCS,Outpatient,,,67,46.9,,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,15.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.95,85,,45.56,percent of total Billed Charges,85% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of total Billed Charges,12.21,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.2,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,12.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.09,56.95,
86015 - Actin (Smooth Muscle) Ab LC,141469,CDM,302,RC,86015,HCPCS,Outpatient,,,55,38.5,,44,80,,35.2,percent of total Billed Charges,80% of Total Billed Charges,9.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,46.75,85,,37.4,percent of total Billed Charges,85% of total Billed Charges,44,80,,35.2,percent of total Billed Charges,80% of total Billed Charges,12.17,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,9.22,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.4,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,44,80,,35.2,percent of total Billed Charges,80% of Total Billed Charges,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.22,46.75,
141383 - Alpha Gal IgE LC,86008,CDM,302,RC,86008,HCPCS,Outpatient,,,81,56.7,,64.8,80,,51.84,percent of total Billed Charges,80% of Total Billed Charges,17.71,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.71,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.85,85,,55.08,percent of total Billed Charges,85% of total Billed Charges,64.8,80,,51.84,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,17.71,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.06,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,64.8,80,,51.84,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.71,68.85,
Anti-Centromere Ab (RDL) LC,140573,CDM,302,RC,86256,HCPCS,Outpatient,,,67,46.9,,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.95,85,,45.56,percent of total Billed Charges,85% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of total Billed Charges,12.17,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.46,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.05,56.95,
86225 - Anti-DNA DS Ab LC,140021,CDM,302,RC,86225,HCPCS,Outpatient,,,76,53.2,,60.8,80,,48.64,percent of total Billed Charges,80% of Total Billed Charges,17.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,64.6,85,,51.68,percent of total Billed Charges,85% of total Billed Charges,60.8,80,,48.64,percent of total Billed Charges,80% of total Billed Charges,13.88,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,17.28,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.63,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60.8,80,,48.64,percent of total Billed Charges,80% of Total Billed Charges,13.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.74,64.6,
86225 - Anti-DNA DS Ab LC,140021,CDM,302,RC,86225,HCPCS,Outpatient,,,76,53.2,,60.8,80,,48.64,percent of total Billed Charges,80% of Total Billed Charges,17.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,64.6,85,,51.68,percent of total Billed Charges,85% of total Billed Charges,60.8,80,,48.64,percent of total Billed Charges,80% of total Billed Charges,13.88,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,17.28,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.63,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60.8,80,,48.64,percent of total Billed Charges,80% of Total Billed Charges,13.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.74,64.6,
86235 - Anti-Jo-1 LC,140369,CDM,302,RC,86235,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,85,
Anti-Jo-1 LC,140369,CDM,302,RC,86235,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,85,
Smith Abs (RDL) LC,140369,CDM,302,RC,86235,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,85,
Anti-U1 RNP Ab (RDL) LC,140369,CDM,302,RC,86235,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,85,
140021 - Anti-dsDNA Antibodies LC,86225,CDM,302,RC,86225,HCPCS,Outpatient,,,76,53.2,,60.8,80,,48.64,percent of total Billed Charges,80% of Total Billed Charges,17.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,64.6,85,,51.68,percent of total Billed Charges,85% of total Billed Charges,60.8,80,,48.64,percent of total Billed Charges,80% of total Billed Charges,13.88,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,17.28,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.63,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60.8,80,,48.64,percent of total Billed Charges,80% of Total Billed Charges,13.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.74,64.6,
86235 - Antichromatin Abs LC,140369,CDM,302,RC,86235,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,85,
141448 - Antineutrophil Cytoplasmic Ab LC,86037,CDM,302,RC,86037,HCPCS,Outpatient,,,55,38.5,,44,80,,35.2,percent of total Billed Charges,80% of Total Billed Charges,9.64,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.64,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,46.75,85,,37.4,percent of total Billed Charges,85% of total Billed Charges,44,80,,35.2,percent of total Billed Charges,80% of total Billed Charges,12.17,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,9.64,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.83,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,44,80,,35.2,percent of total Billed Charges,80% of Total Billed Charges,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.64,46.75,
140020 - Antinuclear Ab (ANA) Qual Multi Immunoassay LC,86038,CDM,302,RC,86038,HCPCS,Outpatient,,,67,46.9,,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,15.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.95,85,,45.56,percent of total Billed Charges,85% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of total Billed Charges,12.21,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.2,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,12.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.09,56.95,
86038 - Antinuclear Antibodies IFA LC,140020,CDM,302,RC,86038,HCPCS,Outpatient,,,67,46.9,,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,15.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.95,85,,45.56,percent of total Billed Charges,85% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of total Billed Charges,12.21,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.2,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,12.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.09,56.95,
86235 - Antiscleroderma-70 Antibodies LC,140369,CDM,302,RC,86235,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,85,
140025 - Antistreptolysin O Ab LC,86060,CDM,302,RC,86060,HCPCS,Outpatient,,,44,30.8,,35.2,80,,28.16,percent of total Billed Charges,80% of Total Billed Charges,8.79,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.79,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,37.4,85,,29.92,percent of total Billed Charges,85% of total Billed Charges,35.2,80,,28.16,percent of total Billed Charges,80% of total Billed Charges,7.37,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.79,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,7.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.97,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,7.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,35.2,80,,28.16,percent of total Billed Charges,80% of Total Billed Charges,7.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.3,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.3,37.4,
Atypical pANCA LC,141448,CDM,302,RC,86037,HCPCS,Outpatient,,,55,38.5,,44,80,,35.2,percent of total Billed Charges,80% of Total Billed Charges,9.64,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.64,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,46.75,85,,37.4,percent of total Billed Charges,85% of total Billed Charges,44,80,,35.2,percent of total Billed Charges,80% of total Billed Charges,12.17,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,9.64,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.83,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,44,80,,35.2,percent of total Billed Charges,80% of Total Billed Charges,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.64,46.75,
140533 - CA 19-9 LC,86301,CDM,302,RC,86301,HCPCS,Outpatient,,,116,81.2,,92.8,80,,74.24,percent of total Billed Charges,80% of Total Billed Charges,26.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,98.6,85,,78.88,percent of total Billed Charges,85% of total Billed Charges,92.8,80,,74.24,percent of total Billed Charges,80% of total Billed Charges,21.02,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,26.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,20.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.68,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,20.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,92.8,80,,74.24,percent of total Billed Charges,80% of Total Billed Charges,20.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.81,98.6,
140867 - CCP Antibodies IgG/IgA LC,86200,CDM,302,RC,86200,HCPCS,Outpatient,,,64,44.8,,51.2,80,,40.96,percent of total Billed Charges,80% of Total Billed Charges,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54.4,85,,43.52,percent of total Billed Charges,85% of total Billed Charges,51.2,80,,40.96,percent of total Billed Charges,80% of total Billed Charges,13.08,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,16.28,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.61,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.2,80,,40.96,percent of total Billed Charges,80% of Total Billed Charges,12.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.95,54.4,
141394 - CD4/CD8 Ratio Profile LC,86360,CDM,302,RC,86360,HCPCS,Outpatient,,,212,148.4,,169.6,80,,135.68,percent of total Billed Charges,80% of Total Billed Charges,59.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,46.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,59.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,180.2,85,,144.16,percent of total Billed Charges,85% of total Billed Charges,169.6,80,,135.68,percent of total Billed Charges,80% of total Billed Charges,47.45,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,59.09,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,46.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60.27,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,46.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,169.6,80,,135.68,percent of total Billed Charges,80% of Total Billed Charges,46.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,46.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,46.98,180.2,
140168 - CRP Quant LC,86140,CDM,302,RC,86140,HCPCS,Outpatient,,,29,20.3,,23.2,80,,18.56,percent of total Billed Charges,80% of Total Billed Charges,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.65,85,,19.72,percent of total Billed Charges,85% of total Billed Charges,23.2,80,,18.56,percent of total Billed Charges,80% of total Billed Charges,5.23,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.51,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.64,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.2,80,,18.56,percent of total Billed Charges,80% of Total Billed Charges,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.18,24.65,
140286 - Cancer Antigen (CA) 125 LC,86304,CDM,302,RC,86304,HCPCS,Outpatient,,,116,81.2,,92.8,80,,74.24,percent of total Billed Charges,80% of Total Billed Charges,26.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,98.6,85,,78.88,percent of total Billed Charges,85% of total Billed Charges,92.8,80,,74.24,percent of total Billed Charges,80% of total Billed Charges,21.02,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,26.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,20.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.68,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,20.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,92.8,80,,74.24,percent of total Billed Charges,80% of Total Billed Charges,20.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.81,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.81,98.6,
86235 - Centromere B Abs LC,140369,CDM,302,RC,86235,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,85,
140051 - Complement C3 LC,86160,CDM,302,RC,86160,HCPCS,Outpatient,,,67,46.9,,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.95,85,,45.56,percent of total Billed Charges,85% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of total Billed Charges,12.12,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.1,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.4,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12,56.95,
86160 - Complement C4 LC,140051,CDM,302,RC,86160,HCPCS,Outpatient,,,67,46.9,,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.95,85,,45.56,percent of total Billed Charges,85% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of total Billed Charges,12.12,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.1,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.4,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12,56.95,
140053 - Complement Total (CH50) LC,86162,CDM,302,RC,86162,HCPCS,Outpatient,,,113,79.1,,90.4,80,,72.32,percent of total Billed Charges,80% of Total Billed Charges,25.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,96.05,85,,76.84,percent of total Billed Charges,85% of total Billed Charges,90.4,80,,72.32,percent of total Billed Charges,80% of total Billed Charges,20.52,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,25.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,20.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.06,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,20.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,90.4,80,,72.32,percent of total Billed Charges,80% of Total Billed Charges,20.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.32,96.05,
Cytoplas C-ANCA LC,141448,CDM,302,RC,86037,HCPCS,Outpatient,,,55,38.5,,44,80,,35.2,percent of total Billed Charges,80% of Total Billed Charges,9.64,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.64,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,46.75,85,,37.4,percent of total Billed Charges,85% of total Billed Charges,44,80,,35.2,percent of total Billed Charges,80% of total Billed Charges,12.17,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,9.64,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.83,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,44,80,,35.2,percent of total Billed Charges,80% of Total Billed Charges,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.64,46.75,
"Antibody; Epstein-Barr (EB) virus, early antigen (EA)",140219,CDM,302,RC,86663,HCPCS,Outpatient,,,59,41.3,,47.2,80,,37.76,percent of total Billed Charges,80% of Total Billed Charges,16.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,50.15,85,,40.12,percent of total Billed Charges,85% of total Billed Charges,47.2,80,,37.76,percent of total Billed Charges,80% of total Billed Charges,13.25,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,16.5,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.83,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,47.2,80,,37.76,percent of total Billed Charges,80% of Total Billed Charges,13.12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.12,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.12,50.15,
141433 - GAD-65 Autoantibody LC,86341,CDM,302,RC,86341,HCPCS,Outpatient,,,95,66.5,,76,80,,60.8,percent of total Billed Charges,80% of Total Billed Charges,24.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.89,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,80.75,85,,64.6,percent of total Billed Charges,85% of total Billed Charges,76,80,,60.8,percent of total Billed Charges,80% of total Billed Charges,23.81,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,24.89,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,23.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.39,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,23.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,76,80,,60.8,percent of total Billed Charges,80% of Total Billed Charges,23.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.57,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.57,80.75,
140372 - HCV Ab LC,86803,CDM,302,RC,86803,HCPCS,Outpatient,,,89,62.3,,71.2,80,,56.96,percent of total Billed Charges,80% of Total Billed Charges,10,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,75.65,85,,60.52,percent of total Billed Charges,85% of total Billed Charges,71.2,80,,56.96,percent of total Billed Charges,80% of total Billed Charges,14.41,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.2,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,71.2,80,,56.96,percent of total Billed Charges,80% of Total Billed Charges,14.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10,75.65,
HCV Antibody RFX to Quant PCR LC,140372,CDM,302,RC,86803,HCPCS,Outpatient,,,89,62.3,,71.2,80,,56.96,percent of total Billed Charges,80% of Total Billed Charges,10,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,75.65,85,,60.52,percent of total Billed Charges,85% of total Billed Charges,71.2,80,,56.96,percent of total Billed Charges,80% of total Billed Charges,14.41,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.2,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,71.2,80,,56.96,percent of total Billed Charges,80% of Total Billed Charges,14.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10,75.65,
86701 - HIV-1 Ab LC,141418,CDM,302,RC,86701,HCPCS,Outpatient,,,40,28,,32,80,,25.6,percent of total Billed Charges,80% of Total Billed Charges,9.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.89,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.7,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34,85,,27.2,percent of total Billed Charges,85% of total Billed Charges,32,80,,25.6,percent of total Billed Charges,80% of total Billed Charges,8.98,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,9.7,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.89,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.89,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.89,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,32,80,,25.6,percent of total Billed Charges,80% of Total Billed Charges,8.89,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.89,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.89,34,
86702 - HIV-2 Ab LC,141419,CDM,302,RC,86702,HCPCS,Outpatient,,,61,42.7,,48.8,80,,39.04,percent of total Billed Charges,80% of Total Billed Charges,14.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.85,85,,41.48,percent of total Billed Charges,85% of total Billed Charges,48.8,80,,39.04,percent of total Billed Charges,80% of total Billed Charges,13.66,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,14.75,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.05,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,48.8,80,,39.04,percent of total Billed Charges,80% of Total Billed Charges,13.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.52,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.52,51.85,
140457 - Hep A Ab IgM LC,86709,CDM,302,RC,86709,HCPCS,Outpatient,,,15,10.5,,12,80,,9.6,percent of total Billed Charges,80% of Total Billed Charges,14.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.75,85,,10.2,percent of total Billed Charges,85% of total Billed Charges,12,80,,9.6,percent of total Billed Charges,80% of total Billed Charges,11.37,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,14.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,11.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.44,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,11.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12,80,,9.6,percent of total Billed Charges,80% of Total Billed Charges,11.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.26,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.26,14.44,
140383 - Hep B Core Ab IgM LC,86705,CDM,302,RC,86705,HCPCS,Outpatient,,,65,45.5,,52,80,,41.6,percent of total Billed Charges,80% of Total Billed Charges,14.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,55.25,85,,44.2,percent of total Billed Charges,85% of total Billed Charges,52,80,,41.6,percent of total Billed Charges,80% of total Billed Charges,11.89,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,14.8,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,11.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.1,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,11.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,52,80,,41.6,percent of total Billed Charges,80% of Total Billed Charges,11.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.77,55.25,
140456 - Hep B Core Ab Tot LC,86704,CDM,302,RC,86704,HCPCS,Outpatient,,,67,46.9,,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.95,85,,45.56,percent of total Billed Charges,85% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of total Billed Charges,12.17,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.46,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.05,56.95,
140117 - Hep B Surf Ab LC,86706,CDM,302,RC,86706,HCPCS,Outpatient,,,60,42,,48,80,,38.4,percent of total Billed Charges,80% of Total Billed Charges,13.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51,85,,40.8,percent of total Billed Charges,85% of total Billed Charges,48,80,,38.4,percent of total Billed Charges,80% of total Billed Charges,10.85,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,13.51,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,10.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.78,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,10.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,48,80,,38.4,percent of total Billed Charges,80% of Total Billed Charges,10.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.74,51,
86317 - Hep B Surf Ab Quant LC,140874,CDM,302,RC,86317,HCPCS,Outpatient,,,75,52.5,,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,15.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,63.75,85,,51,percent of total Billed Charges,85% of total Billed Charges,60,80,,48,percent of total Billed Charges,80% of total Billed Charges,15.14,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.09,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.39,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,14.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.99,63.75,
Immunofixation LC,140575,CDM,302,RC,86334|8278,HCPCS,Outpatient,,,124,86.8,,99.2,80,,79.36,percent of total Billed Charges,80% of Total Billed Charges,78.12,63,,62.496,percent of total Billed charges,63% of Total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total BIlled charges,78.12,63,,62.496,percent of total Billed Charges,63% of total Billed Charges,105.4,85,,84.32,percent of total Billed Charges,85% of total Billed Charges,99.2,80,,79.36,percent of total Billed Charges,80% of total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total Billed Charges,78.12,63,,62.496,percent of total Billed Charges,63% of total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total Billed Charges,78.12,63,,62.496,percent of total billed charges,63% of total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total Billed Charges,99.2,80,,79.36,percent of total Billed Charges,80% of Total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total Billed Charges,76.88,105.4,
141451 - Insulin Abs LC,86337,CDM,302,RC,86337,HCPCS,Outpatient,,,97,67.9,,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,26.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.41,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,26.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,82.45,85,,65.96,percent of total Billed Charges,85% of total Billed Charges,77.6,80,,62.08,percent of total Billed Charges,80% of total Billed Charges,21.62,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,26.93,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,21.41,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.47,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,21.41,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,21.41,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.41,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.41,82.45,
86618 - Lyme Disease Total Antibody with reflex LC,140306,CDM,302,RC,86618,HCPCS,Outpatient,,,99,69.3,,79.2,80,,63.36,percent of total Billed Charges,80% of Total Billed Charges,21.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.03,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,84.15,85,,67.32,percent of total Billed Charges,85% of total Billed Charges,79.2,80,,63.36,percent of total Billed Charges,80% of total Billed Charges,17.2,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,21.42,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.03,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.85,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.03,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,79.2,80,,63.36,percent of total Billed Charges,80% of Total Billed Charges,17.03,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.03,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.03,84.15,
141425 - Lyme IgG/IgM LC,86618,CDM,302,RC,86618,HCPCS,Outpatient,,,77,53.9,,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,21.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.03,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,65.45,85,,52.36,percent of total Billed Charges,85% of total Billed Charges,61.6,80,,49.28,percent of total Billed Charges,80% of total Billed Charges,17.2,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,21.42,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.03,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.85,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.03,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,17.03,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.03,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.03,65.45,
86381 - Mitochondrial (M2) Ab LC,141466,CDM,302,RC,86381,HCPCS,Outpatient,,,115,80.5,,92,80,,73.6,percent of total Billed Charges,80% of Total Billed Charges,20.36,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,25.45,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.36,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,97.75,85,,78.2,percent of total Billed Charges,85% of total Billed Charges,92,80,,73.6,percent of total Billed Charges,80% of total Billed Charges,25.7,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,20.36,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,25.45,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.77,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,25.45,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,92,80,,73.6,percent of total Billed Charges,80% of Total Billed Charges,25.45,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.45,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.36,97.75,
"Mononucleosis Test, Qual LC",140144,CDM,302,RC,86308,HCPCS,Outpatient,,,29,20.3,,23.2,80,,18.56,percent of total Billed Charges,80% of Total Billed Charges,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.51,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.65,85,,19.72,percent of total Billed Charges,85% of total Billed Charges,23.2,80,,18.56,percent of total Billed Charges,80% of total Billed Charges,5.23,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.51,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.64,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.2,80,,18.56,percent of total Billed Charges,80% of Total Billed Charges,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.18,24.65,
"Mumps Antibodies, IgM LC",140423,CDM,302,RC,86735,HCPCS,Outpatient,,,73,51.1,,58.4,80,,46.72,percent of total Billed Charges,80% of Total Billed Charges,16.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.05,85,,49.64,percent of total Billed Charges,85% of total Billed Charges,58.4,80,,46.72,percent of total Billed Charges,80% of total Billed Charges,13.18,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,16.41,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.74,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,58.4,80,,46.72,percent of total Billed Charges,80% of Total Billed Charges,13.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.05,62.05,
86735 - Mumps IgG Abs LC,140423,CDM,302,RC,86735,HCPCS,Outpatient,,,73,51.1,,58.4,80,,46.72,percent of total Billed Charges,80% of Total Billed Charges,16.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.05,85,,49.64,percent of total Billed Charges,85% of total Billed Charges,58.4,80,,46.72,percent of total Billed Charges,80% of total Billed Charges,13.18,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,16.41,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.74,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,58.4,80,,46.72,percent of total Billed Charges,80% of Total Billed Charges,13.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.05,62.05,
Perinuc P-ANCA LC,141448,CDM,302,RC,86037,HCPCS,Outpatient,,,55,38.5,,44,80,,35.2,percent of total Billed Charges,80% of Total Billed Charges,9.64,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.64,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,46.75,85,,37.4,percent of total Billed Charges,85% of total Billed Charges,44,80,,35.2,percent of total Billed Charges,80% of total Billed Charges,12.17,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,9.64,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.83,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,44,80,,35.2,percent of total Billed Charges,80% of Total Billed Charges,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.64,46.75,
Pneumococcal IM (14 Serotype) LC,140874,CDM,302,RC,86317,HCPCS,Outpatient,,,75,52.5,,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,15.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,63.75,85,,51,percent of total Billed Charges,85% of total Billed Charges,60,80,,48,percent of total Billed Charges,80% of total Billed Charges,15.14,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.09,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.39,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,14.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.99,63.75,
141081 - QuantiFERON-TB Gold Plus LC,86480,CDM,302,RC,86480,HCPCS,Outpatient,,,344,240.8,,275.2,80,,220.16,percent of total Billed Charges,80% of Total Billed Charges,77.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,77.93,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,292.4,85,,233.92,percent of total Billed Charges,85% of total Billed Charges,275.2,80,,220.16,percent of total Billed Charges,80% of total Billed Charges,62.6,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,77.93,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,61.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,79.49,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,61.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,275.2,80,,220.16,percent of total Billed Charges,80% of Total Billed Charges,61.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.98,292.4,
86235 - RNP Abs LC,140369,CDM,302,RC,86235,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,85,
86235 - RNP Abs LC,140369,CDM,302,RC,86235,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,85,
140187 - RPR LC,86592,CDM,302,RC,86592,HCPCS,Outpatient,,,24,16.8,,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,4.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.4,85,,16.32,percent of total Billed Charges,85% of total Billed Charges,19.2,80,,15.36,percent of total Billed Charges,80% of total Billed Charges,4.31,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.65,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.74,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.27,20.4,
86593 - RPR Quant LC,140454,CDM,302,RC,86593,HCPCS,Outpatient,,,24,16.8,,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,15.12,63,,12.096,percent of total Billed charges,63% of Total Billed Charges,4.4,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.12,63,,12.096,percent of total Billed Charges,63% of total Billed Charges,20.4,85,,16.32,percent of total Billed Charges,85% of total Billed Charges,19.2,80,,15.36,percent of total Billed Charges,80% of total Billed Charges,4.44,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.12,63,,12.096,percent of total Billed Charges,63% of total Billed Charges,4.4,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.12,63,,12.096,percent of total billed charges,63% of total Billed Charges,4.4,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,4.4,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.4,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.4,20.4,
86592 - RPR Rfx Qn RPR/Confirm TP LC,140187,CDM,302,RC,86592,HCPCS,Outpatient,,,24,16.8,,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,4.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.65,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.4,85,,16.32,percent of total Billed Charges,85% of total Billed Charges,19.2,80,,15.36,percent of total Billed Charges,80% of total Billed Charges,4.31,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.65,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.74,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.27,20.4,
140454 - Rapid Reagin Quant LC,86593,CDM,302,RC,86593,HCPCS,Outpatient,,,24,16.8,,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,15.12,63,,12.096,percent of total Billed charges,63% of Total Billed Charges,4.4,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.12,63,,12.096,percent of total Billed Charges,63% of total Billed Charges,20.4,85,,16.32,percent of total Billed Charges,85% of total Billed Charges,19.2,80,,15.36,percent of total Billed Charges,80% of total Billed Charges,4.44,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.12,63,,12.096,percent of total Billed Charges,63% of total Billed Charges,4.4,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.12,63,,12.096,percent of total billed charges,63% of total Billed Charges,4.4,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,4.4,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.4,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.4,20.4,
Respiratory Syncytial Virus (RSV) NAA 140205 LC,187634,CDM,302,RC,87634,HCPCS,Outpatient,,,316,221.2,,252.8,80,,202.24,percent of total Billed Charges,80% of Total Billed Charges,69.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,70.2,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,69.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,268.6,85,,214.88,percent of total Billed Charges,85% of total Billed Charges,252.8,80,,202.24,percent of total Billed Charges,80% of total Billed Charges,70.9,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,69.33,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,70.2,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,70.72,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,70.2,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,252.8,80,,202.24,percent of total Billed Charges,80% of Total Billed Charges,70.2,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,70.2,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,69.33,268.6,
86431 - Rheumatoid Arthritis Factor LC,141468,CDM,302,RC,86431,HCPCS,Outpatient,,,26,18.2,,20.8,80,,16.64,percent of total Billed Charges,80% of Total Billed Charges,7.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.1,85,,17.68,percent of total Billed Charges,85% of total Billed Charges,20.8,80,,16.64,percent of total Billed Charges,80% of total Billed Charges,5.73,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,7.14,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.28,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.8,80,,16.64,percent of total Billed Charges,80% of Total Billed Charges,5.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.67,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.67,22.1,
86762 - Rubella IgG Abs LC,140188,CDM,302,RC,86762,HCPCS,Outpatient,,,80,56,,64,80,,51.2,percent of total Billed Charges,80% of Total Billed Charges,14.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68,85,,54.4,percent of total Billed Charges,85% of total Billed Charges,64,80,,51.2,percent of total Billed Charges,80% of total Billed Charges,14.53,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,14.63,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.92,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,64,80,,51.2,percent of total Billed Charges,80% of Total Billed Charges,14.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.39,68,
86765 - Rubeola IgG Ab LC,140345,CDM,302,RC,86765,HCPCS,Outpatient,,,72,50.4,,57.6,80,,46.08,percent of total Billed Charges,80% of Total Billed Charges,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.88,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.2,85,,48.96,percent of total Billed Charges,85% of total Billed Charges,57.6,80,,46.08,percent of total Billed Charges,80% of total Billed Charges,13.01,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,16.2,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.88,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.52,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.88,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,57.6,80,,46.08,percent of total Billed Charges,80% of Total Billed Charges,12.88,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.88,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.88,61.2,
87635 - SARS-CoV-2 (COVID-19) PCR (GeneXpert),141416,CDM,302,RC,87635,HCPCS,Outpatient,,,167,116.9,,133.6,80,,106.88,percent of total Billed Charges,80% of Total Billed Charges,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.31,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,141.95,85,,113.56,percent of total Billed Charges,85% of total Billed Charges,133.6,80,,106.88,percent of total Billed Charges,80% of total Billed Charges,51.82,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,51.31,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,51.31,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,52.34,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,51.31,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,133.6,80,,106.88,percent of total Billed Charges,80% of Total Billed Charges,51.31,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.31,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.31,141.95,
141381 - SARS-CoV-2 Antibody IgG LC,86769,CDM,302,RC,86769,HCPCS,Outpatient,,,76,53.2,,60.8,80,,48.64,percent of total Billed Charges,80% of Total Billed Charges,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.13,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,64.6,85,,51.68,percent of total Billed Charges,85% of total Billed Charges,60.8,80,,48.64,percent of total Billed Charges,80% of total Billed Charges,42.55,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,51.31,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,42.13,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,52.34,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,42.13,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60.8,80,,48.64,percent of total Billed Charges,80% of Total Billed Charges,42.13,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.13,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.13,64.6,
86769 - SARS-CoV-2 Semi Quant Total Antibody Spike LC,141381,CDM,302,RC,86769,HCPCS,Outpatient,,,76,53.2,,60.8,80,,48.64,percent of total Billed Charges,80% of Total Billed Charges,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.13,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,64.6,85,,51.68,percent of total Billed Charges,85% of total Billed Charges,60.8,80,,48.64,percent of total Billed Charges,80% of total Billed Charges,42.55,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,51.31,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,42.13,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,52.34,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,42.13,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60.8,80,,48.64,percent of total Billed Charges,80% of Total Billed Charges,42.13,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.13,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.13,64.6,
U0003  - SARS-CoV-2 NAA LC,141473,CDM,302,RC,87635,HCPCS,Outpatient,,,338,236.6,,270.4,80,,216.32,percent of total Billed Charges,80% of Total Billed Charges,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51.31,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,287.3,85,,229.84,percent of total Billed Charges,85% of total Billed Charges,270.4,80,,216.32,percent of total Billed Charges,80% of total Billed Charges,51.82,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,51.31,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,51.31,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,52.34,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,51.31,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,270.4,80,,216.32,percent of total Billed Charges,80% of Total Billed Charges,51.31,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.31,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.31,287.3,
86235 - SCL-70 Abs LC,140369,CDM,302,RC,86235,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,85,
Saccharomyces cerevisiae Profile LC,141431,CDM,302,RC,86671,HCPCS,Outpatient,,,56,39.2,,44.8,80,,35.84,percent of total Billed Charges,80% of Total Billed Charges,15.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,47.6,85,,38.08,percent of total Billed Charges,85% of total Billed Charges,44.8,80,,35.84,percent of total Billed Charges,80% of total Billed Charges,12.37,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.42,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.73,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,44.8,80,,35.84,percent of total Billed Charges,80% of Total Billed Charges,12.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.25,47.6,
86235 - Sjogrens SSA Ab LC,140369,CDM,302,RC,86235,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,85,
86235 - Sjogrens SSA Ab LC,140369,CDM,302,RC,86235,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,85,
86235 - Sjogrens SSA Ab LC,140369,CDM,302,RC,86235,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,85,
86235 - Sjogrens SSB Ab LC,140369,CDM,302,RC,86235,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,85,
86235 - Sjogrens SSB Ab LC,140369,CDM,302,RC,86235,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,85,
86235 - Sjogrens SSB Ab LC,140369,CDM,302,RC,86235,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,85,
86235 - Smith Abs LC,140369,CDM,302,RC,86235,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,85,
86235 - Smith Abs LC,140369,CDM,302,RC,86235,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,85,
Smith/RNP Antibodies LC,140369,CDM,302,RC,86235,HCPCS,Outpatient,,,100,70,,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85,85,,68,percent of total Billed Charges,85% of total Billed Charges,80,80,,64,percent of total Billed Charges,80% of total Billed Charges,18.11,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.55,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,80,80,,64,percent of total Billed Charges,80% of Total Billed Charges,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.93,85,
86780 - T pallidum Abs LC,140267,CDM,302,RC,86780,HCPCS,Outpatient,,,82,57.4,,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,51.66,63,,41.328,percent of total Billed charges,63% of Total Billed Charges,13.24,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.66,63,,41.328,percent of total Billed Charges,63% of total Billed Charges,69.7,85,,55.76,percent of total Billed Charges,85% of total Billed Charges,65.6,80,,52.48,percent of total Billed Charges,80% of total Billed Charges,13.37,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,51.66,63,,41.328,percent of total Billed Charges,63% of total Billed Charges,13.24,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.66,63,,41.328,percent of total billed charges,63% of total Billed Charges,13.24,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,13.24,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.24,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.24,69.7,
86376 - TPO Ab LC,140443,CDM,302,RC,86376,HCPCS,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,18.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,14.7,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,18.3,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.67,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,14.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.55,76.5,
Tetanus Antitoxoid IgG Ab LC,140874,CDM,302,RC,86317,HCPCS,Outpatient,,,75,52.5,,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,15.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,63.75,85,,51,percent of total Billed Charges,85% of total Billed Charges,60,80,,48,percent of total Billed Charges,80% of total Billed Charges,15.14,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.09,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.39,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,14.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.99,63.75,
86800 - Thyroglob Ab LC,140887,CDM,302,RC,86800,HCPCS,Outpatient,,,88,61.6,,70.4,80,,56.32,percent of total Billed Charges,80% of Total Billed Charges,20,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.91,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,74.8,85,,59.84,percent of total Billed Charges,85% of total Billed Charges,70.4,80,,56.32,percent of total Billed Charges,80% of total Billed Charges,16.07,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,20,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,15.91,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.4,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,15.91,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,70.4,80,,56.32,percent of total Billed Charges,80% of Total Billed Charges,15.91,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.91,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.91,74.8,
140443 - Thyroid Peroxidase (TPO) Ab LC,86376,CDM,302,RC,86376,HCPCS,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,18.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,14.7,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,18.3,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.67,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,14.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.55,76.5,
141356 - Toxo gondii AbIgM LC,86778,CDM,302,RC,86778,HCPCS,Outpatient,,,72,50.4,,57.6,80,,46.08,percent of total Billed Charges,80% of Total Billed Charges,18.11,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.41,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.11,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,61.2,85,,48.96,percent of total Billed Charges,85% of total Billed Charges,57.6,80,,46.08,percent of total Billed Charges,80% of total Billed Charges,14.55,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,18.11,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.41,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.47,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.41,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,57.6,80,,46.08,percent of total Billed Charges,80% of Total Billed Charges,14.41,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.41,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.41,61.2,
140267 - Treponema pallidum Antibodies LC,86780,CDM,302,RC,86780,HCPCS,Outpatient,,,82,57.4,,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,51.66,63,,41.328,percent of total Billed charges,63% of Total Billed Charges,13.24,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.66,63,,41.328,percent of total Billed Charges,63% of total Billed Charges,69.7,85,,55.76,percent of total Billed Charges,85% of total Billed Charges,65.6,80,,52.48,percent of total Billed Charges,80% of total Billed Charges,13.37,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,51.66,63,,41.328,percent of total Billed Charges,63% of total Billed Charges,13.24,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.66,63,,41.328,percent of total billed charges,63% of total Billed Charges,13.24,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,13.24,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.24,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.24,69.7,
Tryptase LC,140705,CDM,302,RC,83520,HCPCS,Outpatient,,,64,44.8,,51.2,80,,40.96,percent of total Billed Charges,80% of Total Billed Charges,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.28,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,54.4,85,,43.52,percent of total Billed Charges,85% of total Billed Charges,51.2,80,,40.96,percent of total Billed Charges,80% of total Billed Charges,17.44,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,16.28,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.61,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,51.2,80,,40.96,percent of total Billed Charges,80% of Total Billed Charges,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.28,54.4,
86787 - Varicella-Zoster Ab IgM LC,140255,CDM,302,RC,86787,HCPCS,Outpatient,,,80,56,,64,80,,51.2,percent of total Billed Charges,80% of Total Billed Charges,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.88,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68,85,,54.4,percent of total Billed Charges,85% of total Billed Charges,64,80,,51.2,percent of total Billed Charges,80% of total Billed Charges,13.01,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,16.2,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.88,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.52,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.88,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,64,80,,51.2,percent of total Billed Charges,80% of Total Billed Charges,12.88,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.88,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.88,68,
140255 - Varicella-Zoster V Ab IgG LC,86787,CDM,302,RC,86787,HCPCS,Outpatient,,,80,56,,64,80,,51.2,percent of total Billed Charges,80% of Total Billed Charges,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.88,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68,85,,54.4,percent of total Billed Charges,85% of total Billed Charges,64,80,,51.2,percent of total Billed Charges,80% of total Billed Charges,13.01,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,16.2,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.88,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.52,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.88,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,64,80,,51.2,percent of total Billed Charges,80% of Total Billed Charges,12.88,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.88,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.88,68,
86364 - t-Transglutaminase (tTG) IgA LC,141459,CDM,302,RC,86364,HCPCS,Outpatient,,,52,36.4,,41.6,80,,33.28,percent of total Billed Charges,80% of Total Billed Charges,9.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,44.2,85,,35.36,percent of total Billed Charges,85% of total Billed Charges,41.6,80,,33.28,percent of total Billed Charges,80% of total Billed Charges,11.65,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,9.22,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.4,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,41.6,80,,33.28,percent of total Billed Charges,80% of Total Billed Charges,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.22,44.2,
85613 Lupus Anticoagulant w/ Rfx 117892 LC,140771,CDM,305,RC,85613,HCPCS,Outpatient,,,60,42,,48,80,,38.4,percent of total Billed Charges,80% of Total Billed Charges,12.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51,85,,40.8,percent of total Billed Charges,85% of total Billed Charges,48,80,,38.4,percent of total Billed Charges,80% of total Billed Charges,9.68,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,12.03,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,9.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.27,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,9.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,48,80,,38.4,percent of total Billed Charges,80% of Total Billed Charges,9.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.58,51,
.Hexagonal Phase Phospholipid LC,141437,CDM,305,RC,85598,HCPCS,Outpatient,,,81,56.7,,64.8,80,,51.84,percent of total Billed Charges,80% of Total Billed Charges,20.24,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.24,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.85,85,,55.08,percent of total Billed Charges,85% of total Billed Charges,64.8,80,,51.84,percent of total Billed Charges,80% of total Billed Charges,18.16,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,20.24,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.64,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,64.8,80,,51.84,percent of total Billed Charges,80% of Total Billed Charges,17.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.98,68.85,
.Hemoglobin Solubility LC,141210,CDM,305,RC,85660,HCPCS,Outpatient,,,31,21.7,,24.8,80,,19.84,percent of total Billed Charges,80% of Total Billed Charges,6.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.51,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,26.35,85,,21.08,percent of total Billed Charges,85% of total Billed Charges,24.8,80,,19.84,percent of total Billed Charges,80% of total Billed Charges,5.57,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.94,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.51,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.08,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.51,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.8,80,,19.84,percent of total Billed Charges,80% of Total Billed Charges,5.51,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.51,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.51,26.35,
.Hgb Solubility LC,141210,CDM,305,RC,85660,HCPCS,Outpatient,,,31,21.7,,24.8,80,,19.84,percent of total Billed Charges,80% of Total Billed Charges,6.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.51,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,26.35,85,,21.08,percent of total Billed Charges,85% of total Billed Charges,24.8,80,,19.84,percent of total Billed Charges,80% of total Billed Charges,5.57,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.94,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.51,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.08,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.51,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.8,80,,19.84,percent of total Billed Charges,80% of Total Billed Charges,5.51,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.51,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.51,26.35,
85007 - .Manual Differential (WLMH),140080,CDM,305,RC,85007,HCPCS,Outpatient,,,18,12.6,,14.4,80,,11.52,percent of total Billed Charges,80% of Total Billed Charges,4.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.3,85,,12.24,percent of total Billed Charges,85% of total Billed Charges,14.4,80,,11.52,percent of total Billed Charges,80% of total Billed Charges,3.84,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.33,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,3.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.42,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,3.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.4,80,,11.52,percent of total Billed Charges,80% of Total Billed Charges,3.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.8,15.3,
.PTT-LA Incub Mix LC,140768,CDM,305,RC,85732,HCPCS,Outpatient,,,40,28,,32,80,,25.6,percent of total Billed Charges,80% of Total Billed Charges,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34,85,,27.2,percent of total Billed Charges,85% of total Billed Charges,32,80,,25.6,percent of total Billed Charges,80% of total Billed Charges,6.53,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.14,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.3,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,32,80,,25.6,percent of total Billed Charges,80% of Total Billed Charges,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.47,34,
.PTT-LA Mix LC,140768,CDM,305,RC,85732,HCPCS,Outpatient,,,40,28,,32,80,,25.6,percent of total Billed Charges,80% of Total Billed Charges,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34,85,,27.2,percent of total Billed Charges,85% of total Billed Charges,32,80,,25.6,percent of total Billed Charges,80% of total Billed Charges,6.53,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.14,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.3,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,32,80,,25.6,percent of total Billed Charges,80% of Total Billed Charges,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.47,34,
.dRVVT Confirm,140771,CDM,305,RC,85613,HCPCS,Outpatient,,,60,42,,48,80,,38.4,percent of total Billed Charges,80% of Total Billed Charges,12.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51,85,,40.8,percent of total Billed Charges,85% of total Billed Charges,48,80,,38.4,percent of total Billed Charges,80% of total Billed Charges,9.68,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,12.03,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,9.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.27,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,9.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,48,80,,38.4,percent of total Billed Charges,80% of Total Billed Charges,9.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.58,51,
.dRVVT Mix,140771,CDM,305,RC,85613,HCPCS,Outpatient,,,60,42,,48,80,,38.4,percent of total Billed Charges,80% of Total Billed Charges,12.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,51,85,,40.8,percent of total Billed Charges,85% of total Billed Charges,48,80,,38.4,percent of total Billed Charges,80% of total Billed Charges,9.68,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,12.03,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,9.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.27,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,9.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,48,80,,38.4,percent of total Billed Charges,80% of Total Billed Charges,9.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.58,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.58,51,
85025 - CBC w/ Differential,140113,CDM,305,RC,85025,HCPCS,Outpatient,,,35,24.5,,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,9.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.75,85,,23.8,percent of total Billed Charges,85% of total Billed Charges,28,80,,22.4,percent of total Billed Charges,80% of total Billed Charges,7.85,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,9.77,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,7.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.97,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,7.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,7.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.77,29.75,
85025 - CBC w/ Manual Diff,140113,CDM,305,RC,85025,HCPCS,Outpatient,,,35,24.5,,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,9.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.75,85,,23.8,percent of total Billed Charges,85% of total Billed Charges,28,80,,22.4,percent of total Billed Charges,80% of total Billed Charges,7.85,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,9.77,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,7.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.97,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,7.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,7.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.77,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.77,29.75,
85379 - D-Dimer,140538,CDM,305,RC,85379,HCPCS,Outpatient,,,57,39.9,,45.6,80,,36.48,percent of total Billed Charges,80% of Total Billed Charges,12.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,48.45,85,,38.76,percent of total Billed Charges,85% of total Billed Charges,45.6,80,,36.48,percent of total Billed Charges,80% of total Billed Charges,10.28,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,12.8,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,10.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.06,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,10.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,45.6,80,,36.48,percent of total Billed Charges,80% of Total Billed Charges,10.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.18,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.18,48.45,
ESR (Erythrocyte Sedimentation Rate),141491,CDM,305,RC,85652,HCPCS,Outpatient,,,13,9.1,,10.4,80,,8.32,percent of total Billed Charges,80% of Total Billed Charges,3.39,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,2.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.39,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.05,85,,8.84,percent of total Billed Charges,85% of total Billed Charges,10.4,80,,8.32,percent of total Billed Charges,80% of total Billed Charges,2.73,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,3.39,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,2.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.46,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,2.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.4,80,,8.32,percent of total Billed Charges,80% of Total Billed Charges,2.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.7,11.05,
85651 - ESR Westergren,140191,CDM,305,RC,85651,HCPCS,Outpatient,,,20,14,,16,80,,12.8,percent of total Billed Charges,80% of Total Billed Charges,4.46,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.46,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17,85,,13.6,percent of total Billed Charges,85% of total Billed Charges,16,80,,12.8,percent of total Billed Charges,80% of total Billed Charges,4.31,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.46,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.55,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16,80,,12.8,percent of total Billed Charges,80% of Total Billed Charges,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.27,17,
Fibrinogen Activity LC,140098,CDM,305,RC,85384,HCPCS,Outpatient,,,47,32.9,,37.6,80,,30.08,percent of total Billed Charges,80% of Total Billed Charges,10.68,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.72,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.68,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,39.95,85,,31.96,percent of total Billed Charges,85% of total Billed Charges,37.6,80,,30.08,percent of total Billed Charges,80% of total Billed Charges,9.82,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.68,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,9.72,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.89,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,9.72,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,37.6,80,,30.08,percent of total Billed Charges,80% of Total Billed Charges,9.72,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.72,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.72,39.95,
85014 - Hematocrit,140596,CDM,305,RC,85014,HCPCS,Outpatient,,,13,9.1,,10.4,80,,8.32,percent of total Billed Charges,80% of Total Billed Charges,2.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,2.37,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.05,85,,8.84,percent of total Billed Charges,85% of total Billed Charges,10.4,80,,8.32,percent of total Billed Charges,80% of total Billed Charges,2.39,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,2.98,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,2.37,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.04,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,2.37,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.4,80,,8.32,percent of total Billed Charges,80% of Total Billed Charges,2.37,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.37,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.37,11.05,
85014 - Hct LC,140596,CDM,305,RC,85014,HCPCS,Outpatient,,,13,9.1,,10.4,80,,8.32,percent of total Billed Charges,80% of Total Billed Charges,2.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,2.37,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.05,85,,8.84,percent of total Billed Charges,85% of total Billed Charges,10.4,80,,8.32,percent of total Billed Charges,80% of total Billed Charges,2.39,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,2.98,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,2.37,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.04,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,2.37,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.4,80,,8.32,percent of total Billed Charges,80% of Total Billed Charges,2.37,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.37,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.37,11.05,
140081 - Hematopath Consultation Smear LC,85060,CDM,305,RC,85060,HCPCS,Outpatient,,,20,14,,16,80,,12.8,percent of total Billed Charges,80% of Total Billed Charges,25.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.4,62,,9.92,percent of total Billed Charges,62% of total BIlled charges,25.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17,85,,13.6,percent of total Billed Charges,85% of total Billed Charges,16,80,,12.8,percent of total Billed Charges,80% of total Billed Charges,12.4,62,,9.92,percent of total Billed Charges,62% of total Billed Charges,25.97,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.4,62,,9.92,percent of total Billed Charges,62% of total Billed Charges,26.49,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.4,62,,9.92,percent of total Billed Charges,62% of total Billed Charges,16,80,,12.8,percent of total Billed Charges,80% of Total Billed Charges,12.4,62,,9.92,percent of total Billed Charges,62% of total Billed Charges,12.4,62,,9.92,percent of total Billed Charges,62% of total Billed Charges,12.4,26.49,
85018 - Hemoglobin,140597,CDM,305,RC,85018,HCPCS,Outpatient,,,13,9.1,,10.4,80,,8.32,percent of total Billed Charges,80% of Total Billed Charges,2.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,2.37,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.05,85,,8.84,percent of total Billed Charges,85% of total Billed Charges,10.4,80,,8.32,percent of total Billed Charges,80% of total Billed Charges,2.39,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,2.98,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,2.37,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.04,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,2.37,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.4,80,,8.32,percent of total Billed Charges,80% of Total Billed Charges,2.37,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.37,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.37,11.05,
Lupus Anticoagulant w/ Rfx 117892 LC,140768,CDM,305,RC,85732,HCPCS,Outpatient,,,40,28,,32,80,,25.6,percent of total Billed Charges,80% of Total Billed Charges,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34,85,,27.2,percent of total Billed Charges,85% of total Billed Charges,32,80,,25.6,percent of total Billed Charges,80% of total Billed Charges,6.53,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.14,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.3,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,32,80,,25.6,percent of total Billed Charges,80% of Total Billed Charges,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.47,34,
141232 - Lysozyme Serum LC,85549,CDM,305,RC,85549,HCPCS,Outpatient,,,104,72.8,,83.2,80,,66.56,percent of total Billed Charges,80% of Total Billed Charges,23.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,88.4,85,,70.72,percent of total Billed Charges,85% of total Billed Charges,83.2,80,,66.56,percent of total Billed Charges,80% of total Billed Charges,18.94,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,23.59,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,18.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.06,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,18.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,83.2,80,,66.56,percent of total Billed Charges,80% of Total Billed Charges,18.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.75,88.4,
85610 - Prothrombin Time and INR,140179,CDM,305,RC,85610,HCPCS,Outpatient,,,22,15.4,,17.6,80,,14.08,percent of total Billed Charges,80% of Total Billed Charges,4.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.29,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.94,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,18.7,85,,14.96,percent of total Billed Charges,85% of total Billed Charges,17.6,80,,14.08,percent of total Billed Charges,80% of total Billed Charges,4.33,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,4.94,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,4.29,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.04,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,4.29,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.6,80,,14.08,percent of total Billed Charges,80% of Total Billed Charges,4.29,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.29,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.29,18.7,
85730 - Partial Thromboplastin Time,140024,CDM,305,RC,85730,HCPCS,Outpatient,,,38,26.6,,30.4,80,,24.32,percent of total Billed Charges,80% of Total Billed Charges,7.54,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.01,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.54,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,32.3,85,,25.84,percent of total Billed Charges,85% of total Billed Charges,30.4,80,,24.32,percent of total Billed Charges,80% of total Billed Charges,6.07,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,7.54,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.01,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.69,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.01,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,30.4,80,,24.32,percent of total Billed Charges,80% of Total Billed Charges,6.01,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.01,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.01,32.3,
85049 - Platelet Count,140698,CDM,305,RC,85049,HCPCS,Outpatient,,,25,17.5,,20,80,,16,percent of total Billed Charges,80% of Total Billed Charges,5.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.48,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.63,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.25,85,,17,percent of total Billed Charges,85% of total Billed Charges,20,80,,16,percent of total Billed Charges,80% of total Billed Charges,4.52,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,5.63,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,4.48,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.74,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,4.48,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20,80,,16,percent of total Billed Charges,80% of Total Billed Charges,4.48,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.48,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.48,21.25,
85302 - Protein C Ag LC,141070,CDM,305,RC,85302,HCPCS,Outpatient,,,67,46.9,,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,15.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.01,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.95,85,,45.56,percent of total Billed Charges,85% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of total Billed Charges,12.13,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.12,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,12.01,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.42,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,12.01,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,12.01,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.01,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.01,56.95,
85303 - Protein C Funct LC,140568,CDM,305,RC,85303,HCPCS,Outpatient,,,77,53.9,,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,17.39,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.39,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,65.45,85,,52.36,percent of total Billed Charges,85% of total Billed Charges,61.6,80,,49.28,percent of total Billed Charges,80% of total Billed Charges,13.98,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,17.39,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.74,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,13.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.84,65.45,
85305 - Protein S Total LC,141067,CDM,305,RC,85305,HCPCS,Outpatient,,,65,45.5,,52,80,,41.6,percent of total Billed Charges,80% of Total Billed Charges,14.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,55.25,85,,44.2,percent of total Billed Charges,85% of total Billed Charges,52,80,,41.6,percent of total Billed Charges,80% of total Billed Charges,11.73,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,14.58,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,11.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.87,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,11.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,52,80,,41.6,percent of total Billed Charges,80% of Total Billed Charges,11.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.61,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.61,55.25,
85045 - Retic Count,141445,CDM,305,RC,85045,HCPCS,Outpatient,,,18,12.6,,14.4,80,,11.52,percent of total Billed Charges,80% of Total Billed Charges,5.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.03,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,15.3,85,,12.24,percent of total Billed Charges,85% of total Billed Charges,14.4,80,,11.52,percent of total Billed Charges,80% of total Billed Charges,4.03,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,5.03,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,3.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.13,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,3.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.4,80,,11.52,percent of total Billed Charges,80% of Total Billed Charges,3.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.99,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.99,15.3,
Sedimentation Rate-Westergren LC,141490,CDM,305,RC,85652,HCPCS,Outpatient,,,13,9.1,,10.4,80,,8.32,percent of total Billed Charges,80% of Total Billed Charges,3.39,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,2.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.39,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.05,85,,8.84,percent of total Billed Charges,85% of total Billed Charges,10.4,80,,8.32,percent of total Billed Charges,80% of total Billed Charges,2.73,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,3.39,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,2.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.46,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,2.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.4,80,,8.32,percent of total Billed Charges,80% of Total Billed Charges,2.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.7,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.7,11.05,
"87075 Body fluidCulture, Aerobic and Anaerobic, with Grams S",141377,CDM,306,RC,87075,HCPCS,Outpatient,,,34,23.8,,27.2,80,,21.76,percent of total Billed Charges,80% of Total Billed Charges,11.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.9,85,,23.12,percent of total Billed Charges,85% of total Billed Charges,27.2,80,,21.76,percent of total Billed Charges,80% of total Billed Charges,9.56,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,11.9,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,9.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.14,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,9.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.2,80,,21.76,percent of total Billed Charges,80% of Total Billed Charges,9.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.47,28.9,
"87205 Body fluidCulture, Aerobic and Anaerobic, with Grams S",140200,CDM,306,RC,87205,HCPCS,Outpatient,,,24,16.8,,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,2.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.4,85,,16.32,percent of total Billed Charges,85% of total Billed Charges,19.2,80,,15.36,percent of total Billed Charges,80% of total Billed Charges,4.31,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,2.95,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.01,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.95,20.4,
87206,187206,CDM,306,RC,87206,HCPCS,Outpatient,,,25,17.5,,20,80,,16,percent of total Billed Charges,80% of Total Billed Charges,6.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.25,85,,17,percent of total Billed Charges,85% of total Billed Charges,20,80,,16,percent of total Billed Charges,80% of total Billed Charges,5.44,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.75,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.89,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20,80,,16,percent of total Billed Charges,80% of Total Billed Charges,5.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.39,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.39,21.25,
"Rotavirus, Direct Detection",141201,CDM,306,RC,87425,HCPCS,Outpatient,,,25,17.5,,20,80,,16,percent of total Billed Charges,80% of Total Billed Charges,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.25,85,,17,percent of total Billed Charges,85% of total Billed Charges,20,80,,16,percent of total Billed Charges,80% of total Billed Charges,12.1,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20,80,,16,percent of total Billed Charges,80% of Total Billed Charges,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.98,21.25,
Laboratory services,140787,CDM,306,RC,87522,HCPCS,Outpatient,,,238,166.6,,190.4,80,,152.32,percent of total Billed Charges,80% of Total Billed Charges,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,202.3,85,,161.84,percent of total Billed Charges,85% of total Billed Charges,190.4,80,,152.32,percent of total Billed Charges,80% of total Billed Charges,43.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,53.87,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,54.95,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,190.4,80,,152.32,percent of total Billed Charges,80% of Total Billed Charges,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.84,202.3,
"87798- Genital Mycoplasma Profile, NAA, Urine LC",141370,CDM,306,RC,87798,HCPCS,Outpatient,,,158,110.6,,126.4,80,,101.12,percent of total Billed Charges,80% of Total Billed Charges,24.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,35.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,134.3,85,,107.44,percent of total Billed Charges,85% of total Billed Charges,126.4,80,,101.12,percent of total Billed Charges,80% of total Billed Charges,35.44,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,24.67,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,35.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.16,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,35.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,126.4,80,,101.12,percent of total Billed Charges,80% of Total Billed Charges,35.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,35.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.67,134.3,
87077 - Gram Positive ID,141215,CDM,306,RC,87077,HCPCS,Outpatient,,,48,33.6,,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,10.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.8,85,,32.64,percent of total Billed Charges,85% of total Billed Charges,38.4,80,,30.72,percent of total Billed Charges,80% of total Billed Charges,8.16,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.36,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.08,40.8,
87077 - Gram negative ID,141215,CDM,306,RC,87077,HCPCS,Outpatient,,,48,33.6,,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,10.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.8,85,,32.64,percent of total Billed Charges,85% of total Billed Charges,38.4,80,,30.72,percent of total Billed Charges,80% of total Billed Charges,8.16,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.36,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.08,40.8,
87804 ADD-ON Influenza B,140697,CDM,306,RC,87804,HCPCS,Outpatient,,,75,52.5,,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,63.75,85,,51,percent of total Billed Charges,85% of total Billed Charges,60,80,,48,percent of total Billed Charges,80% of total Billed Charges,16.72,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,16.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,63.75,
.Aerobic Bact ID by Seq 183269 LC,187158,CDM,306,RC,87158,HCPCS,Outpatient,,,35,24.5,,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.75,85,,23.8,percent of total Billed Charges,85% of total Billed Charges,28,80,,22.4,percent of total Billed Charges,80% of total Billed Charges,7.82,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.58,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.71,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.58,29.75,
.Anaerobic Bact ID by Seq 183301 LC,141293,CDM,306,RC,87153,HCPCS,Outpatient,,,195,136.5,,156,80,,124.8,percent of total Billed Charges,80% of Total Billed Charges,122.85,63,,98.28,percent of total Billed charges,63% of Total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,122.85,63,,98.28,percent of total Billed Charges,63% of total Billed Charges,165.75,85,,132.6,percent of total Billed Charges,85% of total Billed Charges,156,80,,124.8,percent of total Billed Charges,80% of total Billed Charges,116.51,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,122.85,63,,98.28,percent of total Billed Charges,63% of total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,122.85,63,,98.28,percent of total billed charges,63% of total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,156,80,,124.8,percent of total Billed Charges,80% of Total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,115.36,165.75,
.Anaerobic Org Id 183303 LC,187158,CDM,306,RC,87158,HCPCS,Outpatient,,,35,24.5,,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.75,85,,23.8,percent of total Billed Charges,85% of total Billed Charges,28,80,,22.4,percent of total Billed Charges,80% of total Billed Charges,7.82,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.58,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.71,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.58,29.75,
.Mold ID by Seq 183327 LC,141293,CDM,306,RC,87153,HCPCS,Outpatient,,,195,136.5,,156,80,,124.8,percent of total Billed Charges,80% of Total Billed Charges,122.85,63,,98.28,percent of total Billed charges,63% of Total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,122.85,63,,98.28,percent of total Billed Charges,63% of total Billed Charges,165.75,85,,132.6,percent of total Billed Charges,85% of total Billed Charges,156,80,,124.8,percent of total Billed Charges,80% of total Billed Charges,116.51,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,122.85,63,,98.28,percent of total Billed Charges,63% of total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,122.85,63,,98.28,percent of total billed charges,63% of total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,156,80,,124.8,percent of total Billed Charges,80% of Total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,115.36,165.75,
.Mold Org Id 183329 LC,187158,CDM,306,RC,87158,HCPCS,Outpatient,,,35,24.5,,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.75,85,,23.8,percent of total Billed Charges,85% of total Billed Charges,28,80,,22.4,percent of total Billed Charges,80% of total Billed Charges,7.82,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.58,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.71,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.58,29.75,
.Mycobact ID by Seq 183293 LC,141293,CDM,306,RC,87153,HCPCS,Outpatient,,,195,136.5,,156,80,,124.8,percent of total Billed Charges,80% of Total Billed Charges,122.85,63,,98.28,percent of total Billed charges,63% of Total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,122.85,63,,98.28,percent of total Billed Charges,63% of total Billed Charges,165.75,85,,132.6,percent of total Billed Charges,85% of total Billed Charges,156,80,,124.8,percent of total Billed Charges,80% of total Billed Charges,116.51,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,122.85,63,,98.28,percent of total Billed Charges,63% of total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,122.85,63,,98.28,percent of total billed charges,63% of total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,156,80,,124.8,percent of total Billed Charges,80% of Total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,115.36,165.75,
.Mycobacteria Org Id 183295 LC,187158,CDM,306,RC,87158,HCPCS,Outpatient,,,35,24.5,,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.75,85,,23.8,percent of total Billed Charges,85% of total Billed Charges,28,80,,22.4,percent of total Billed Charges,80% of total Billed Charges,7.82,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.58,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.71,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.58,29.75,
.Nocardia ID by Seq 183277 LC,141293,CDM,306,RC,87153,HCPCS,Outpatient,,,195,136.5,,156,80,,124.8,percent of total Billed Charges,80% of Total Billed Charges,122.85,63,,98.28,percent of total Billed charges,63% of Total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,122.85,63,,98.28,percent of total Billed Charges,63% of total Billed Charges,165.75,85,,132.6,percent of total Billed Charges,85% of total Billed Charges,156,80,,124.8,percent of total Billed Charges,80% of total Billed Charges,116.51,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,122.85,63,,98.28,percent of total Billed Charges,63% of total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,122.85,63,,98.28,percent of total billed charges,63% of total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,156,80,,124.8,percent of total Billed Charges,80% of Total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,115.36,165.75,
.Nocardia Org Id 183279 LC,187158,CDM,306,RC,87158,HCPCS,Outpatient,,,35,24.5,,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.75,85,,23.8,percent of total Billed Charges,85% of total Billed Charges,28,80,,22.4,percent of total Billed Charges,80% of total Billed Charges,7.82,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.58,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.71,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.58,29.75,
.Organism ID by Sequencing LC,141293,CDM,306,RC,87153,HCPCS,Outpatient,,,195,136.5,,156,80,,124.8,percent of total Billed Charges,80% of Total Billed Charges,122.85,63,,98.28,percent of total Billed charges,63% of Total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,122.85,63,,98.28,percent of total Billed Charges,63% of total Billed Charges,165.75,85,,132.6,percent of total Billed Charges,85% of total Billed Charges,156,80,,124.8,percent of total Billed Charges,80% of total Billed Charges,116.51,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,122.85,63,,98.28,percent of total Billed Charges,63% of total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,122.85,63,,98.28,percent of total billed charges,63% of total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,156,80,,124.8,percent of total Billed Charges,80% of Total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,115.36,165.75,
87070 - .Sputum Culture 182354 LC,141215,CDM,306,RC,87070,HCPCS,Outpatient,,,48,33.6,,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.8,85,,32.64,percent of total Billed Charges,85% of total Billed Charges,38.4,80,,30.72,percent of total Billed Charges,80% of total Billed Charges,8.71,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.83,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.05,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.62,40.8,
.Yeast ID by Seq 183319 LC,141293,CDM,306,RC,87153,HCPCS,Outpatient,,,195,136.5,,156,80,,124.8,percent of total Billed Charges,80% of Total Billed Charges,122.85,63,,98.28,percent of total Billed charges,63% of Total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,122.85,63,,98.28,percent of total Billed Charges,63% of total Billed Charges,165.75,85,,132.6,percent of total Billed Charges,85% of total Billed Charges,156,80,,124.8,percent of total Billed Charges,80% of total Billed Charges,116.51,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,122.85,63,,98.28,percent of total Billed Charges,63% of total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,122.85,63,,98.28,percent of total billed charges,63% of total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,156,80,,124.8,percent of total Billed Charges,80% of Total Billed Charges,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,115.36,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,115.36,165.75,
.Yeast Org Id 183321 LC,187158,CDM,306,RC,87158,HCPCS,Outpatient,,,35,24.5,,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.75,85,,23.8,percent of total Billed Charges,85% of total Billed Charges,28,80,,22.4,percent of total Billed Charges,80% of total Billed Charges,7.82,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.58,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.71,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.74,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.58,29.75,
Acid Fast Smear+Culture W/Rflx LC,187116,CDM,306,RC,87116,HCPCS,Outpatient,,,49,34.3,,39.2,80,,31.36,percent of total Billed Charges,80% of Total Billed Charges,30.87,63,,24.696,percent of total Billed charges,63% of Total Billed Charges,10.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,30.87,63,,24.696,percent of total Billed Charges,63% of total Billed Charges,41.65,85,,33.32,percent of total Billed Charges,85% of total Billed Charges,39.2,80,,31.36,percent of total Billed Charges,80% of total Billed Charges,10.91,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,30.87,63,,24.696,percent of total Billed Charges,63% of total Billed Charges,10.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,30.87,63,,24.696,percent of total billed charges,63% of total Billed Charges,10.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,39.2,80,,31.36,percent of total Billed Charges,80% of Total Billed Charges,10.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.8,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.8,41.65,
Adenovirus(40/41)/Rotavirus EIA LC,141461,CDM,306,RC,87301,HCPCS,Outpatient,,,54,37.8,,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.9,85,,36.72,percent of total Billed Charges,85% of total Billed Charges,43.2,80,,34.56,percent of total Billed Charges,80% of total Billed Charges,12.1,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.98,45.9,
141334 - Aerobe ID + Suscept LC,87077,CDM,306,RC,87077,HCPCS,Outpatient,,,50,35,,40,80,,32,percent of total Billed Charges,80% of Total Billed Charges,10.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.5,85,,34,percent of total Billed Charges,85% of total Billed Charges,40,80,,32,percent of total Billed Charges,80% of total Billed Charges,8.16,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.36,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,40,80,,32,percent of total Billed Charges,80% of Total Billed Charges,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.08,42.5,
141215 - Aerobic Bacterial Culture LC,87070,CDM,306,RC,87070,HCPCS,Outpatient,,,48,33.6,,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.8,85,,32.64,percent of total Billed Charges,85% of total Billed Charges,38.4,80,,30.72,percent of total Billed Charges,80% of total Billed Charges,8.71,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.83,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.05,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.62,40.8,
87070 - Aerobic Cult Status: LC,141215,CDM,306,RC,87070,HCPCS,Outpatient,,,48,33.6,,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.8,85,,32.64,percent of total Billed Charges,85% of total Billed Charges,38.4,80,,30.72,percent of total Billed Charges,80% of total Billed Charges,8.71,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.83,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.05,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.62,40.8,
141145 - Anaerobe Identification Only LC,87076,CDM,306,RC,87076,HCPCS,Outpatient,,,45,31.5,,36,80,,28.8,percent of total Billed Charges,80% of Total Billed Charges,10.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,38.25,85,,30.6,percent of total Billed Charges,85% of total Billed Charges,36,80,,28.8,percent of total Billed Charges,80% of total Billed Charges,8.16,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.36,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,36,80,,28.8,percent of total Billed Charges,80% of Total Billed Charges,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.08,38.25,
87075 - Anaerobic Cult Status: LC,141377,CDM,306,RC,87075,HCPCS,Outpatient,,,34,23.8,,27.2,80,,21.76,percent of total Billed Charges,80% of Total Billed Charges,11.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,28.9,85,,23.12,percent of total Billed Charges,85% of total Billed Charges,27.2,80,,21.76,percent of total Billed Charges,80% of total Billed Charges,9.56,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,11.9,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,9.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.14,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,9.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.2,80,,21.76,percent of total Billed Charges,80% of Total Billed Charges,9.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.47,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.47,28.9,
"Body Fluid Culture, Sterile LC",141215,CDM,306,RC,87070,HCPCS,Outpatient,,,48,33.6,,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.8,85,,32.64,percent of total Billed Charges,85% of total Billed Charges,38.4,80,,30.72,percent of total Billed Charges,80% of total Billed Charges,8.71,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.83,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.05,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.62,40.8,
"Body fluidCulture, Aerobic and Anaerobic, with Grams Stain L",141215,CDM,306,RC,87070,HCPCS,Outpatient,,,48,33.6,,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.8,85,,32.64,percent of total Billed Charges,85% of total Billed Charges,38.4,80,,30.72,percent of total Billed Charges,80% of total Billed Charges,8.71,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.83,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.05,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.62,40.8,
87491 - C trach NAA LC,140488,CDM,306,RC,87491,HCPCS,Outpatient,,,195,136.5,,156,80,,124.8,percent of total Billed Charges,80% of Total Billed Charges,24.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,35.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,165.75,85,,132.6,percent of total Billed Charges,85% of total Billed Charges,156,80,,124.8,percent of total Billed Charges,80% of total Billed Charges,35.44,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,24.67,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,35.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,25.16,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,35.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,156,80,,124.8,percent of total Billed Charges,80% of Total Billed Charges,35.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,35.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.67,165.75,
141016 - CMV Quant DNA PCR LC,87497,CDM,306,RC,87497,HCPCS,Outpatient,,,238,166.6,,190.4,80,,152.32,percent of total Billed Charges,80% of Total Billed Charges,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,202.3,85,,161.84,percent of total Billed Charges,85% of total Billed Charges,190.4,80,,152.32,percent of total Billed Charges,80% of total Billed Charges,43.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,53.87,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,54.95,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,190.4,80,,152.32,percent of total Billed Charges,80% of Total Billed Charges,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.84,202.3,
87046 - Campylobacter Cult Status LC,140775,CDM,306,RC,87046,HCPCS,Outpatient,,,52,36.4,,41.6,80,,33.28,percent of total Billed Charges,80% of Total Billed Charges,2.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.44,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,44.2,85,,35.36,percent of total Billed Charges,85% of total Billed Charges,41.6,80,,33.28,percent of total Billed Charges,80% of total Billed Charges,9.53,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,2.97,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,9.44,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.03,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,9.44,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,41.6,80,,33.28,percent of total Billed Charges,80% of Total Billed Charges,9.44,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.44,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.97,44.2,
87324 - Clostridium Difficile,140048,CDM,306,RC,87324,HCPCS,Outpatient,,,67,46.9,,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,56.95,85,,45.56,percent of total Billed Charges,85% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of total Billed Charges,12.1,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.98,56.95,
87428 - Coronavirus SARS/Flu Ag (Sofia),141446,CDM,306,RC,87428,HCPCS,Outpatient,,,140,98,,112,80,,89.6,percent of total Billed Charges,80% of Total Billed Charges,67.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,70.29,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,67.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,119,85,,95.2,percent of total Billed Charges,85% of total Billed Charges,112,80,,89.6,percent of total Billed Charges,80% of total Billed Charges,70.99,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,67.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,70.29,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,68.42,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,70.29,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,112,80,,89.6,percent of total Billed Charges,80% of Total Billed Charges,70.29,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,70.29,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,67.08,119,
Cryptosporidium EIA LC,141452,CDM,306,RC,87328,HCPCS,Outpatient,,,63,44.1,,50.4,80,,40.32,percent of total Billed Charges,80% of Total Billed Charges,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.82,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,53.55,85,,42.84,percent of total Billed Charges,85% of total Billed Charges,50.4,80,,40.32,percent of total Billed Charges,80% of total Billed Charges,13.96,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.82,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.82,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,50.4,80,,40.32,percent of total Billed Charges,80% of Total Billed Charges,13.82,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.82,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.82,53.55,
87427 - E coli Shiga Toxin EIA LC,141462,CDM,306,RC,87427,HCPCS,Outpatient,,,54,37.8,,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.9,85,,36.72,percent of total Billed Charges,85% of total Billed Charges,43.2,80,,34.56,percent of total Billed Charges,80% of total Billed Charges,12.1,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.98,45.9,
141009 - Epstein-Barr DNA Quant PCR LC,87799,CDM,306,RC,87799,HCPCS,Outpatient,,,265,185.5,,212,80,,169.6,percent of total Billed Charges,80% of Total Billed Charges,166.95,63,,133.56,percent of total Billed charges,63% of Total Billed Charges,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,166.95,63,,133.56,percent of total Billed Charges,63% of total Billed Charges,225.25,85,,180.2,percent of total Billed Charges,85% of total Billed Charges,212,80,,169.6,percent of total Billed Charges,80% of total Billed Charges,43.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,166.95,63,,133.56,percent of total Billed Charges,63% of total Billed Charges,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,166.95,63,,133.56,percent of total billed charges,63% of total Billed Charges,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,212,80,,169.6,percent of total Billed Charges,80% of Total Billed Charges,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.84,225.25,
87210 - Fern Test,141312,CDM,306,RC,87210,HCPCS,Outpatient,,,44,30.8,,35.2,80,,28.16,percent of total Billed Charges,80% of Total Billed Charges,5.36,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.82,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.36,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,37.4,85,,29.92,percent of total Billed Charges,85% of total Billed Charges,35.2,80,,28.16,percent of total Billed Charges,80% of total Billed Charges,5.88,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,5.36,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.82,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.47,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.82,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,35.2,80,,28.16,percent of total Billed Charges,80% of Total Billed Charges,5.82,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.82,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.36,37.4,
Fungus (Mycology) Culture LC,141267,CDM,306,RC,87101,HCPCS,Outpatient,,,29,20.3,,23.2,80,,18.56,percent of total Billed Charges,80% of Total Billed Charges,9.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,7.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.65,85,,19.72,percent of total Billed Charges,85% of total Billed Charges,23.2,80,,18.56,percent of total Billed Charges,80% of total Billed Charges,7.79,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,9.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,7.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.88,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,7.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.2,80,,18.56,percent of total Billed Charges,80% of Total Billed Charges,7.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.71,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,7.71,24.65,
"GI Profile, Stool, PCR LC",141453,CDM,306,RC,87507,HCPCS,Outpatient,,,1876,1313.2,,1500.8,80,,1200.64,percent of total Billed Charges,80% of Total Billed Charges,333.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,416.78,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,333.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,1594.6,85,,1275.68,percent of total Billed Charges,85% of total Billed Charges,1500.8,80,,1200.64,percent of total Billed Charges,80% of total Billed Charges,420.95,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,333.42,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,416.78,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,340.09,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,416.78,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,1500.8,80,,1200.64,percent of total Billed Charges,80% of Total Billed Charges,416.78,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,416.78,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,333.42,1594.6,
"Genital Culture, Routine LC",141215,CDM,306,RC,87070,HCPCS,Outpatient,,,48,33.6,,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.8,85,,32.64,percent of total Billed Charges,85% of total Billed Charges,38.4,80,,30.72,percent of total Billed Charges,80% of total Billed Charges,8.71,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.83,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.05,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.62,40.8,
"Genital Mycoplasma Profile, NAA, Urine LC",141456,CDM,306,RC,87563,HCPCS,Outpatient,,,158,110.6,,126.4,80,,101.12,percent of total Billed Charges,80% of Total Billed Charges,28.07,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,35.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28.07,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,134.3,85,,107.44,percent of total Billed Charges,85% of total Billed Charges,126.4,80,,101.12,percent of total Billed Charges,80% of total Billed Charges,35.44,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,28.07,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,35.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28.63,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,35.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,126.4,80,,101.12,percent of total Billed Charges,80% of Total Billed Charges,35.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,35.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,28.07,134.3,
140429 - Giardia lamblia Ag EIA LC,87329,CDM,306,RC,87329,HCPCS,Outpatient,,,50,35,,40,80,,32,percent of total Billed Charges,80% of Total Billed Charges,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.5,85,,34,percent of total Billed Charges,85% of total Billed Charges,40,80,,32,percent of total Billed Charges,80% of total Billed Charges,12.1,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,40,80,,32,percent of total Billed Charges,80% of Total Billed Charges,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.98,42.5,
"HCV RNA by PCR, Reflex to Geno LC",140787,CDM,306,RC,87522,HCPCS,Outpatient,,,238,166.6,,190.4,80,,152.32,percent of total Billed Charges,80% of Total Billed Charges,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,202.3,85,,161.84,percent of total Billed Charges,85% of total Billed Charges,190.4,80,,152.32,percent of total Billed Charges,80% of total Billed Charges,43.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,53.87,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,54.95,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,190.4,80,,152.32,percent of total Billed Charges,80% of Total Billed Charges,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.84,202.3,
140787 - HCV RT-PCR Quant (Non-Graph) LC,87522,CDM,306,RC,87522,HCPCS,Outpatient,,,238,166.6,,190.4,80,,152.32,percent of total Billed Charges,80% of Total Billed Charges,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,202.3,85,,161.84,percent of total Billed Charges,85% of total Billed Charges,190.4,80,,152.32,percent of total Billed Charges,80% of total Billed Charges,43.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,53.87,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,54.95,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,190.4,80,,152.32,percent of total Billed Charges,80% of Total Billed Charges,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.84,202.3,
141173 - HIV-1/O/2 4th Generation LC,87389,CDM,306,RC,87389,HCPCS,Outpatient,,,134,93.8,,107.2,80,,85.76,percent of total Billed Charges,80% of Total Billed Charges,27.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,24.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,113.9,85,,91.12,percent of total Billed Charges,85% of total Billed Charges,107.2,80,,85.76,percent of total Billed Charges,80% of total Billed Charges,24.32,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,27.3,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,24.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,27.85,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,24.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,107.2,80,,85.76,percent of total Billed Charges,80% of Total Billed Charges,24.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,24.08,113.9,
140837 - Helicobacter pylori Stool Ag EIA LC,87338,CDM,306,RC,87338,HCPCS,Outpatient,,,80,56,,64,80,,51.2,percent of total Billed Charges,80% of Total Billed Charges,18.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.38,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68,85,,54.4,percent of total Billed Charges,85% of total Billed Charges,64,80,,51.2,percent of total Billed Charges,80% of total Billed Charges,14.52,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,18.09,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,14.38,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,18.45,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,14.38,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,64,80,,51.2,percent of total Billed Charges,80% of Total Billed Charges,14.38,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.38,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,14.38,68,
140116 - Hep B Surf Antigen Scr LC,87340,CDM,306,RC,87340,HCPCS,Outpatient,,,57,39.9,,45.6,80,,36.48,percent of total Billed Charges,80% of Total Billed Charges,12.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.33,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,48.45,85,,38.76,percent of total Billed Charges,85% of total Billed Charges,45.6,80,,36.48,percent of total Billed Charges,80% of total Billed Charges,10.43,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,12.99,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,10.33,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.25,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,10.33,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,45.6,80,,36.48,percent of total Billed Charges,80% of Total Billed Charges,10.33,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.33,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.33,48.45,
87804 - Influenza A  and B,140697,CDM,306,RC,87804,HCPCS,Outpatient,,,75,52.5,,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,63.75,85,,51,percent of total Billed Charges,85% of total Billed Charges,60,80,,48,percent of total Billed Charges,80% of total Billed Charges,16.72,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,16.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.55,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,63.75,
L. pneumophila Serogp 1 Ur Ag LC,141385,CDM,306,RC,87449,HCPCS,Outpatient,,,54,37.8,,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.9,85,,36.72,percent of total Billed Charges,85% of total Billed Charges,43.2,80,,34.56,percent of total Billed Charges,80% of total Billed Charges,12.1,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.98,45.9,
Lower Respiratory Culture LC,141215,CDM,306,RC,87070,HCPCS,Outpatient,,,48,33.6,,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.8,85,,32.64,percent of total Billed Charges,85% of total Billed Charges,38.4,80,,30.72,percent of total Billed Charges,80% of total Billed Charges,8.71,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.83,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.05,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.62,40.8,
141178 - MRSA Screening Culture LC,87081,CDM,306,RC,87081,HCPCS,Outpatient,,,37,25.9,,29.6,80,,23.68,percent of total Billed Charges,80% of Total Billed Charges,8.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.33,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,31.45,85,,25.16,percent of total Billed Charges,85% of total Billed Charges,29.6,80,,23.68,percent of total Billed Charges,80% of total Billed Charges,6.7,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,8.33,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,29.6,80,,23.68,percent of total Billed Charges,80% of Total Billed Charges,6.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.63,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.63,31.45,
87591 - N gonorrhoeae NAA LC,140603,CDM,306,RC,87591,HCPCS,Outpatient,,,195,136.5,,156,80,,124.8,percent of total Billed Charges,80% of Total Billed Charges,21.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,35.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,165.75,85,,132.6,percent of total Billed Charges,85% of total Billed Charges,156,80,,124.8,percent of total Billed Charges,80% of total Billed Charges,35.44,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,21.42,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,35.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.85,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,35.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,156,80,,124.8,percent of total Billed Charges,80% of Total Billed Charges,35.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,35.09,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.42,165.75,
87077 - Organism ID Bacteria LC,141334,CDM,306,RC,87077,HCPCS,Outpatient,,,50,35,,40,80,,32,percent of total Billed Charges,80% of Total Billed Charges,10.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.5,85,,34,percent of total Billed Charges,85% of total Billed Charges,40,80,,32,percent of total Billed Charges,80% of total Billed Charges,8.16,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.36,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,40,80,,32,percent of total Billed Charges,80% of Total Billed Charges,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.08,42.5,
87177 - Ova + Parasite Status LC,140151,CDM,306,RC,87177,HCPCS,Outpatient,,,49,34.3,,39.2,80,,31.36,percent of total Billed Charges,80% of Total Billed Charges,11.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.9,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,41.65,85,,33.32,percent of total Billed Charges,85% of total Billed Charges,39.2,80,,31.36,percent of total Billed Charges,80% of total Billed Charges,8.99,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,11.19,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.9,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.41,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.9,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,39.2,80,,31.36,percent of total Billed Charges,80% of Total Billed Charges,8.9,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.9,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.9,41.65,
87209 - Ova + Parasite Status-Prelim LC,141465,CDM,306,RC,87209,HCPCS,Outpatient,,,81,56.7,,64.8,80,,51.84,percent of total Billed Charges,80% of Total Billed Charges,22.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,68.85,85,,55.08,percent of total Billed Charges,85% of total Billed Charges,64.8,80,,51.84,percent of total Billed Charges,80% of total Billed Charges,18.16,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,22.6,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,17.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,23.05,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,17.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,64.8,80,,51.84,percent of total Billed Charges,80% of Total Billed Charges,17.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.98,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,17.98,68.85,
140929 - RNA RT PCR (Non-Graph) LC,87536,CDM,306,RC,87536,HCPCS,Outpatient,,,321,224.7,,256.8,80,,205.44,percent of total Billed Charges,80% of Total Billed Charges,56.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,85.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,56.5,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,272.85,85,,218.28,percent of total Billed Charges,85% of total Billed Charges,256.8,80,,205.44,percent of total Billed Charges,80% of total Billed Charges,85.95,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,56.5,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,85.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,57.63,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,85.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,256.8,80,,205.44,percent of total Billed Charges,80% of Total Billed Charges,85.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,85.1,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,56.5,272.85,
87420 - RSV Ag EIA LC,141472,CDM,306,RC,87420,HCPCS,Outpatient,,,63,44.1,,50.4,80,,40.32,percent of total Billed Charges,80% of Total Billed Charges,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,13.91,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,53.55,85,,42.84,percent of total Billed Charges,85% of total Billed Charges,50.4,80,,40.32,percent of total Billed Charges,80% of total Billed Charges,14.05,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,13.91,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,13.91,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,50.4,80,,40.32,percent of total Billed Charges,80% of Total Billed Charges,13.91,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.91,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.91,53.55,
87045 - Salmonella/Shigella Scr LC,140067,CDM,306,RC,87045,HCPCS,Outpatient,,,52,36.4,,41.6,80,,33.28,percent of total Billed Charges,80% of Total Billed Charges,32.76,63,,26.208,percent of total Billed charges,63% of Total Billed Charges,9.44,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,32.76,63,,26.208,percent of total Billed Charges,63% of total Billed Charges,44.2,85,,35.36,percent of total Billed Charges,85% of total Billed Charges,41.6,80,,33.28,percent of total Billed Charges,80% of total Billed Charges,9.53,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,32.76,63,,26.208,percent of total Billed Charges,63% of total Billed Charges,9.44,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,32.76,63,,26.208,percent of total billed charges,63% of total Billed Charges,9.44,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,41.6,80,,33.28,percent of total Billed Charges,80% of Total Billed Charges,9.44,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.44,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,9.44,44.2,
87205 - Sputum Cult w/ Gram Stain LC,140200,CDM,306,RC,87205,HCPCS,Outpatient,,,24,16.8,,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,2.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.4,85,,16.32,percent of total Billed Charges,85% of total Billed Charges,19.2,80,,15.36,percent of total Billed Charges,80% of total Billed Charges,4.31,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,2.95,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.01,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.95,20.4,
87880 - Strep A Rapid,140257,CDM,306,RC,87880,HCPCS,Outpatient,,,74,51.8,,59.2,80,,47.36,percent of total Billed Charges,80% of Total Billed Charges,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.9,85,,50.32,percent of total Billed Charges,85% of total Billed Charges,59.2,80,,47.36,percent of total Billed Charges,80% of total Billed Charges,16.7,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,59.2,80,,47.36,percent of total Billed Charges,80% of Total Billed Charges,16.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,62.9,
87186 - Susceptibility Gram Pos Rods LC,140075,CDM,306,RC,87186,HCPCS,Outpatient,,,54,37.8,,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,10.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.9,85,,36.72,percent of total Billed Charges,85% of total Billed Charges,43.2,80,,34.56,percent of total Billed Charges,80% of total Billed Charges,8.74,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.87,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.09,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,8.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.65,45.9,
87210 - Wet Prep,141312,CDM,306,RC,87210,HCPCS,Outpatient,,,44,30.8,,35.2,80,,28.16,percent of total Billed Charges,80% of Total Billed Charges,5.36,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.82,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.36,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,37.4,85,,29.92,percent of total Billed Charges,85% of total Billed Charges,35.2,80,,28.16,percent of total Billed Charges,80% of total Billed Charges,5.88,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,5.36,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.82,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.47,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.82,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,35.2,80,,28.16,percent of total Billed Charges,80% of Total Billed Charges,5.82,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.82,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.36,37.4,
140290 - White Blood Cells (WBC) Stool LC,89055,CDM,306,RC,89055,HCPCS,Outpatient,,,15,10.5,,12,80,,9.6,percent of total Billed Charges,80% of Total Billed Charges,2.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.75,85,,10.2,percent of total Billed Charges,85% of total Billed Charges,12,80,,9.6,percent of total Billed Charges,80% of total Billed Charges,4.31,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,2.95,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.01,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12,80,,9.6,percent of total Billed Charges,80% of Total Billed Charges,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.95,12.75,
87185 - Beta Lactamase,140778,CDM,306,RC,87185,HCPCS,Outpatient,,,26,18.2,,20.8,80,,16.64,percent of total Billed Charges,80% of Total Billed Charges,5.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,22.1,85,,17.68,percent of total Billed Charges,85% of total Billed Charges,20.8,80,,16.64,percent of total Billed Charges,80% of total Billed Charges,4.8,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,5.98,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,4.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.1,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,4.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,20.8,80,,16.64,percent of total Billed Charges,80% of Total Billed Charges,4.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.75,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.75,22.1,
87040 - Blood Culture,140063,CDM,306,RC,87040,HCPCS,Outpatient,,,57,39.9,,45.6,80,,36.48,percent of total Billed Charges,80% of Total Billed Charges,12.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,10.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12.98,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,48.45,85,,38.76,percent of total Billed Charges,85% of total Billed Charges,45.6,80,,36.48,percent of total Billed Charges,80% of total Billed Charges,10.42,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,12.98,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,10.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.24,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,10.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,45.6,80,,36.48,percent of total Billed Charges,80% of Total Billed Charges,10.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.32,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.32,48.45,
87205 - Gram Stain Report,140200,CDM,306,RC,87205,HCPCS,Outpatient,,,24,16.8,,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,2.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.4,85,,16.32,percent of total Billed Charges,85% of total Billed Charges,19.2,80,,15.36,percent of total Billed Charges,80% of total Billed Charges,4.31,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,2.95,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.01,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.27,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.95,20.4,
Laboratory services,141334,CDM,306,RC,87077,HCPCS,Outpatient,,,50,35,,40,80,,32,percent of total Billed Charges,80% of Total Billed Charges,10.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.5,85,,34,percent of total Billed Charges,85% of total Billed Charges,40,80,,32,percent of total Billed Charges,80% of total Billed Charges,8.16,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.36,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,40,80,,32,percent of total Billed Charges,80% of Total Billed Charges,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.08,42.5,
87880 - Quickvue Rapid Strp A ID,140257,CDM,306,RC,87880,HCPCS,Outpatient,,,74,51.8,,59.2,80,,47.36,percent of total Billed Charges,80% of Total Billed Charges,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,16.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,62.9,85,,50.32,percent of total Billed Charges,85% of total Billed Charges,59.2,80,,47.36,percent of total Billed Charges,80% of total Billed Charges,16.7,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,16.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,16.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,59.2,80,,47.36,percent of total Billed Charges,80% of Total Billed Charges,16.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,16.53,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,62.9,
Laboratory services,141334,CDM,306,RC,87077,HCPCS,Outpatient,,,50,35,,40,80,,32,percent of total Billed Charges,80% of Total Billed Charges,10.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.16,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.5,85,,34,percent of total Billed Charges,85% of total Billed Charges,40,80,,32,percent of total Billed Charges,80% of total Billed Charges,8.16,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.16,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.36,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,40,80,,32,percent of total Billed Charges,80% of Total Billed Charges,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.08,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.08,42.5,
87070 - Throat Culture,141215,CDM,306,RC,87070,HCPCS,Outpatient,,,48,33.6,,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,40.8,85,,32.64,percent of total Billed Charges,85% of total Billed Charges,38.4,80,,30.72,percent of total Billed Charges,80% of total Billed Charges,8.71,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.83,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.05,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,38.4,80,,30.72,percent of total Billed Charges,80% of Total Billed Charges,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.62,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.62,40.8,
87086 - Urine Culture,140072,CDM,306,RC,87086,HCPCS,Outpatient,,,45,31.5,,36,80,,28.8,percent of total Billed Charges,80% of Total Billed Charges,10.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.07,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.15,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,38.25,85,,30.6,percent of total Billed Charges,85% of total Billed Charges,36,80,,28.8,percent of total Billed Charges,80% of total Billed Charges,8.15,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.15,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.07,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.35,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.07,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,36,80,,28.8,percent of total Billed Charges,80% of Total Billed Charges,8.07,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.07,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.07,38.25,
87186 - WLMH NC68,140075,CDM,306,RC,87186,HCPCS,Outpatient,,,54,37.8,,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,10.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.9,85,,36.72,percent of total Billed Charges,85% of total Billed Charges,43.2,80,,34.56,percent of total Billed Charges,80% of total Billed Charges,8.74,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.87,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.09,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,8.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.65,45.9,
Laboratory services,140075,CDM,306,RC,87186,HCPCS,Outpatient,,,54,37.8,,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,10.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.9,85,,36.72,percent of total Billed Charges,85% of total Billed Charges,43.2,80,,34.56,percent of total Billed Charges,80% of total Billed Charges,8.74,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.87,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.09,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,8.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.65,45.9,
87186 - WLMH PC45,140075,CDM,306,RC,87186,HCPCS,Outpatient,,,54,37.8,,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,10.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,8.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,10.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,45.9,85,,36.72,percent of total Billed Charges,85% of total Billed Charges,43.2,80,,34.56,percent of total Billed Charges,80% of total Billed Charges,8.74,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,10.87,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,8.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.09,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,8.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,43.2,80,,34.56,percent of total Billed Charges,80% of Total Billed Charges,8.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.65,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.65,45.9,
81001 Urinalysis w/ Microscopic Exam,140212,CDM,307,RC,81001,HCPCS,Outpatient,,,15,10.5,,12,80,,9.6,percent of total Billed Charges,80% of Total Billed Charges,3.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.99,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,12.75,85,,10.2,percent of total Billed Charges,85% of total Billed Charges,12,80,,9.6,percent of total Billed Charges,80% of total Billed Charges,3.2,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,3.99,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,3.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,4.07,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,3.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,12,80,,9.6,percent of total Billed Charges,80% of Total Billed Charges,3.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.17,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.17,12.75,
86335 - Immunofixation Ur LC,141281,CDM,307,RC,86335,HCPCS,Outpatient,,,49,34.3,,39.2,80,,31.36,percent of total Billed Charges,80% of Total Billed Charges,36.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,29.35,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,36.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,41.65,85,,33.32,percent of total Billed Charges,85% of total Billed Charges,39.2,80,,31.36,percent of total Billed Charges,80% of total Billed Charges,29.64,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,36.9,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,29.35,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,37.64,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,29.35,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,39.2,80,,31.36,percent of total Billed Charges,80% of Total Billed Charges,29.35,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,29.35,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,29.35,41.65,
81003 - Urinalysis Dipstick Only,140612,CDM,307,RC,81003,HCPCS,Outpatient,,,11,7.7,,8.8,80,,7.04,percent of total Billed Charges,80% of Total Billed Charges,2.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,2.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.35,85,,7.48,percent of total Billed Charges,85% of total Billed Charges,8.8,80,,7.04,percent of total Billed Charges,80% of total Billed Charges,2.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,2.83,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,2.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.89,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,2.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.8,80,,7.04,percent of total Billed Charges,80% of Total Billed Charges,2.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.25,9.35,
81015 - UA Microscopic,141478,CDM,307,RC,81015,HCPCS,Outpatient,,,14,9.8,,11.2,80,,8.96,percent of total Billed Charges,80% of Total Billed Charges,3.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.82,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,11.9,85,,9.52,percent of total Billed Charges,85% of total Billed Charges,11.2,80,,8.96,percent of total Billed Charges,80% of total Billed Charges,3.08,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,3.82,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,3.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.9,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,3.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,11.2,80,,8.96,percent of total Billed Charges,80% of Total Billed Charges,3.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.05,11.9,
81003 - Urinalysis with Microscopic if Indicated,140612,CDM,307,RC,81003,HCPCS,Outpatient,,,11,7.7,,8.8,80,,7.04,percent of total Billed Charges,80% of Total Billed Charges,2.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,2.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.35,85,,7.48,percent of total Billed Charges,85% of total Billed Charges,8.8,80,,7.04,percent of total Billed Charges,80% of total Billed Charges,2.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,2.83,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,2.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.89,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,2.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.8,80,,7.04,percent of total Billed Charges,80% of Total Billed Charges,2.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.25,9.35,
81003 - Urinalysis With Micro if Indicated and Culture if In,140612,CDM,307,RC,81003,HCPCS,Outpatient,,,11,7.7,,8.8,80,,7.04,percent of total Billed Charges,80% of Total Billed Charges,2.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,2.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.83,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,9.35,85,,7.48,percent of total Billed Charges,85% of total Billed Charges,8.8,80,,7.04,percent of total Billed Charges,80% of total Billed Charges,2.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,2.83,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,2.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.89,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,2.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,8.8,80,,7.04,percent of total Billed Charges,80% of Total Billed Charges,2.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.25,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.25,9.35,
"Volume measurement, 24 hr urine",140441,CDM,307,RC,81050,HCPCS,Outpatient,,,17,11.9,,13.6,80,,10.88,percent of total Billed Charges,80% of Total Billed Charges,3.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,3.64,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,14.45,85,,11.56,percent of total Billed Charges,85% of total Billed Charges,13.6,80,,10.88,percent of total Billed Charges,80% of total Billed Charges,3.68,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,3.77,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,3.64,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.85,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,3.64,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,13.6,80,,10.88,percent of total Billed Charges,80% of Total Billed Charges,3.64,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.64,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,3.64,14.45,
Cell Ct Synovial w/o Crystals LC,140342,CDM,309,RC,89051,HCPCS,Outpatient,,,28,19.6,,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,2.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,5.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,23.8,85,,19.04,percent of total Billed Charges,85% of total Billed Charges,22.4,80,,17.92,percent of total Billed Charges,80% of total Billed Charges,5.66,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,2.21,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,5.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.25,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,5.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,22.4,80,,17.92,percent of total Billed Charges,80% of Total Billed Charges,5.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,5.6,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,2.21,23.8,
"Crystal, Synovial/Joint Fl LC",140394,CDM,309,RC,83615,HCPCS,Outpatient,,,84,58.8,,67.2,80,,53.76,percent of total Billed Charges,80% of Total Billed Charges,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,6.04,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,71.4,85,,57.12,percent of total Billed Charges,85% of total Billed Charges,67.2,80,,53.76,percent of total Billed Charges,80% of total Billed Charges,6.1,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,6.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,6.04,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.48,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,6.04,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,67.2,80,,53.76,percent of total Billed Charges,80% of Total Billed Charges,6.04,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.04,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,6.04,71.4,
88300 Bill Only Surg Path Level I,140734,CDM,310,RC,88300,HCPCS,Outpatient,,,55,38.5,,44,80,,35.2,percent of total Billed Charges,80% of Total Billed Charges,14.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,34.1,62,,27.28,percent of total Billed Charges,62% of total BIlled charges,14.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,46.75,85,,37.4,percent of total Billed Charges,85% of total Billed Charges,44,80,,35.2,percent of total Billed Charges,80% of total Billed Charges,34.1,62,,27.28,percent of total Billed Charges,62% of total Billed Charges,14.3,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,34.1,62,,27.28,percent of total Billed Charges,62% of total Billed Charges,14.59,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,34.1,62,,27.28,percent of total Billed Charges,62% of total Billed Charges,44,80,,35.2,percent of total Billed Charges,80% of Total Billed Charges,34.1,62,,27.28,percent of total Billed Charges,62% of total Billed Charges,34.1,62,,27.28,percent of total Billed Charges,62% of total Billed Charges,14.3,46.75,
88302 - Bill Only Surg Path Level II,140735,CDM,310,RC,88302,HCPCS,Outpatient,,,189,132.3,,151.2,80,,120.96,percent of total Billed Charges,80% of Total Billed Charges,35.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,117.18,62,,93.744,percent of total Billed Charges,62% of total BIlled charges,35.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,160.65,85,,128.52,percent of total Billed Charges,85% of total Billed Charges,151.2,80,,120.96,percent of total Billed Charges,80% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,35.06,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,35.76,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,151.2,80,,120.96,percent of total Billed Charges,80% of Total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,35.06,160.65,
88304 - Bill Only Surg Path Level III,140736,CDM,310,RC,88304,HCPCS,Outpatient,,,133,93.1,,106.4,80,,85.12,percent of total Billed Charges,80% of Total Billed Charges,30.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,82.46,62,,65.968,percent of total Billed Charges,62% of total BIlled charges,30.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,113.05,85,,90.44,percent of total Billed Charges,85% of total Billed Charges,106.4,80,,85.12,percent of total Billed Charges,80% of total Billed Charges,82.46,62,,65.968,percent of total Billed Charges,62% of total Billed Charges,30.18,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,82.46,62,,65.968,percent of total Billed Charges,62% of total Billed Charges,30.78,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,82.46,62,,65.968,percent of total Billed Charges,62% of total Billed Charges,106.4,80,,85.12,percent of total Billed Charges,80% of Total Billed Charges,82.46,62,,65.968,percent of total Billed Charges,62% of total Billed Charges,82.46,62,,65.968,percent of total Billed Charges,62% of total Billed Charges,30.18,113.05,
88305 - Bill Only Surg Path Level IV,140435,CDM,310,RC,88305,HCPCS,Outpatient,,,136,95.2,,108.8,80,,87.04,percent of total Billed Charges,80% of Total Billed Charges,65.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,84.32,62,,67.456,percent of total Billed Charges,62% of total BIlled charges,65.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,115.6,85,,92.48,percent of total Billed Charges,85% of total Billed Charges,108.8,80,,87.04,percent of total Billed Charges,80% of total Billed Charges,84.32,62,,67.456,percent of total Billed Charges,62% of total Billed Charges,65.88,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,84.32,62,,67.456,percent of total Billed Charges,62% of total Billed Charges,67.2,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,84.32,62,,67.456,percent of total Billed Charges,62% of total Billed Charges,108.8,80,,87.04,percent of total Billed Charges,80% of Total Billed Charges,84.32,62,,67.456,percent of total Billed Charges,62% of total Billed Charges,84.32,62,,67.456,percent of total Billed Charges,62% of total Billed Charges,65.88,115.6,
88307 - Bill Only Surg Path Level V,140738,CDM,310,RC,88307,HCPCS,Outpatient,,,820,574,,656,80,,524.8,percent of total Billed Charges,80% of Total Billed Charges,133.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,508.4,62,,406.72,percent of total Billed Charges,62% of total BIlled charges,133.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,697,85,,557.6,percent of total Billed Charges,85% of total Billed Charges,656,80,,524.8,percent of total Billed Charges,80% of total Billed Charges,508.4,62,,406.72,percent of total Billed Charges,62% of total Billed Charges,133.3,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,508.4,62,,406.72,percent of total Billed Charges,62% of total Billed Charges,135.97,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,508.4,62,,406.72,percent of total Billed Charges,62% of total Billed Charges,656,80,,524.8,percent of total Billed Charges,80% of Total Billed Charges,508.4,62,,406.72,percent of total Billed Charges,62% of total Billed Charges,508.4,62,,406.72,percent of total Billed Charges,62% of total Billed Charges,133.3,697,
88309 - Bill Only Surg Path Level VI,140739,CDM,310,RC,88309,HCPCS,Outpatient,,,1144,800.8,,915.2,80,,732.16,percent of total Billed Charges,80% of Total Billed Charges,187.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,709.28,62,,567.424,percent of total Billed Charges,62% of total BIlled charges,187.78,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,972.4,85,,777.92,percent of total Billed Charges,85% of total Billed Charges,915.2,80,,732.16,percent of total Billed Charges,80% of total Billed Charges,709.28,62,,567.424,percent of total Billed Charges,62% of total Billed Charges,187.78,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,709.28,62,,567.424,percent of total Billed Charges,62% of total Billed Charges,191.54,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,709.28,62,,567.424,percent of total Billed Charges,62% of total Billed Charges,915.2,80,,732.16,percent of total Billed Charges,80% of Total Billed Charges,709.28,62,,567.424,percent of total Billed Charges,62% of total Billed Charges,709.28,62,,567.424,percent of total Billed Charges,62% of total Billed Charges,187.78,972.4,
88311 - Bill Only Decalcification,140485,CDM,310,RC,88311,HCPCS,Outpatient,,,102,71.4,,81.6,80,,65.28,percent of total Billed Charges,80% of Total Billed Charges,15.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,63.24,62,,50.592,percent of total Billed Charges,62% of total BIlled charges,15.45,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,86.7,85,,69.36,percent of total Billed Charges,85% of total Billed Charges,81.6,80,,65.28,percent of total Billed Charges,80% of total Billed Charges,63.24,62,,50.592,percent of total Billed Charges,62% of total Billed Charges,15.45,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,63.24,62,,50.592,percent of total Billed Charges,62% of total Billed Charges,15.76,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,63.24,62,,50.592,percent of total Billed Charges,62% of total Billed Charges,81.6,80,,65.28,percent of total Billed Charges,80% of Total Billed Charges,63.24,62,,50.592,percent of total Billed Charges,62% of total Billed Charges,63.24,62,,50.592,percent of total Billed Charges,62% of total Billed Charges,15.45,86.7,
88312 - Bill Only Special Stain Group 1,140314,CDM,310,RC,88312,HCPCS,Outpatient,,,447,312.9,,357.6,80,,286.08,percent of total Billed Charges,80% of Total Billed Charges,43.39,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,277.14,62,,221.712,percent of total Billed Charges,62% of total BIlled charges,43.39,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,379.95,85,,303.96,percent of total Billed Charges,85% of total Billed Charges,357.6,80,,286.08,percent of total Billed Charges,80% of total Billed Charges,277.14,62,,221.712,percent of total Billed Charges,62% of total Billed Charges,43.39,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,277.14,62,,221.712,percent of total Billed Charges,62% of total Billed Charges,44.26,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,277.14,62,,221.712,percent of total Billed Charges,62% of total Billed Charges,357.6,80,,286.08,percent of total Billed Charges,80% of Total Billed Charges,277.14,62,,221.712,percent of total Billed Charges,62% of total Billed Charges,277.14,62,,221.712,percent of total Billed Charges,62% of total Billed Charges,43.39,379.95,
88313 - Bill Only Special Stain Group 2,140737,CDM,310,RC,88313,HCPCS,Outpatient,,,324,226.8,,259.2,80,,207.36,percent of total Billed Charges,80% of Total Billed Charges,44.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,200.88,62,,160.704,percent of total Billed Charges,62% of total BIlled charges,44.91,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,275.4,85,,220.32,percent of total Billed Charges,85% of total Billed Charges,259.2,80,,207.36,percent of total Billed Charges,80% of total Billed Charges,200.88,62,,160.704,percent of total Billed Charges,62% of total Billed Charges,44.91,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,200.88,62,,160.704,percent of total Billed Charges,62% of total Billed Charges,45.81,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,200.88,62,,160.704,percent of total Billed Charges,62% of total Billed Charges,259.2,80,,207.36,percent of total Billed Charges,80% of Total Billed Charges,200.88,62,,160.704,percent of total Billed Charges,62% of total Billed Charges,200.88,62,,160.704,percent of total Billed Charges,62% of total Billed Charges,44.91,275.4,
88341 - Bill Only IHC Ea Addtl Ab Stain,140740,CDM,310,RC,88341,HCPCS,Outpatient,,,165,115.5,,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,57.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,102.3,62,,81.84,percent of total Billed Charges,62% of total BIlled charges,57.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,140.25,85,,112.2,percent of total Billed Charges,85% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,57.38,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,58.53,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,57.38,140.25,
88342 - Bill Only IHC Ea Stain,141139,CDM,310,RC,88342,HCPCS,Outpatient,,,123,86.1,,98.4,80,,78.72,percent of total Billed Charges,80% of Total Billed Charges,71.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,76.26,62,,61.008,percent of total Billed Charges,62% of total BIlled charges,71.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,104.55,85,,83.64,percent of total Billed Charges,85% of total Billed Charges,98.4,80,,78.72,percent of total Billed Charges,80% of total Billed Charges,76.26,62,,61.008,percent of total Billed Charges,62% of total Billed Charges,71.58,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,76.26,62,,61.008,percent of total Billed Charges,62% of total Billed Charges,73.01,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,76.26,62,,61.008,percent of total Billed Charges,62% of total Billed Charges,98.4,80,,78.72,percent of total Billed Charges,80% of Total Billed Charges,76.26,62,,61.008,percent of total Billed Charges,62% of total Billed Charges,76.26,62,,61.008,percent of total Billed Charges,62% of total Billed Charges,71.58,104.55,
"HBV RT PCR, Quant LC",140794,CDM,310,RC,87517,HCPCS,Outpatient,,,238,166.6,,190.4,80,,152.32,percent of total Billed Charges,80% of Total Billed Charges,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,53.87,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,202.3,85,,161.84,percent of total Billed Charges,85% of total Billed Charges,190.4,80,,152.32,percent of total Billed Charges,80% of total Billed Charges,43.27,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,53.87,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,54.95,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,190.4,80,,152.32,percent of total Billed Charges,80% of Total Billed Charges,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.84,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,42.84,202.3,
141089 - Urine Cytology LC,88112,CDM,310,RC,88112,HCPCS,Outpatient,,,316,221.2,,252.8,80,,202.24,percent of total Billed Charges,80% of Total Billed Charges,106.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,195.92,62,,156.736,percent of total Billed Charges,62% of total BIlled charges,106.19,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,268.6,85,,214.88,percent of total Billed Charges,85% of total Billed Charges,252.8,80,,202.24,percent of total Billed Charges,80% of total Billed Charges,195.92,62,,156.736,percent of total Billed Charges,62% of total Billed Charges,106.19,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,195.92,62,,156.736,percent of total Billed Charges,62% of total Billed Charges,108.31,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,195.92,62,,156.736,percent of total Billed Charges,62% of total Billed Charges,252.8,80,,202.24,percent of total Billed Charges,80% of Total Billed Charges,195.92,62,,156.736,percent of total Billed Charges,62% of total Billed Charges,195.92,62,,156.736,percent of total Billed Charges,62% of total Billed Charges,106.19,268.6,
77081 - BD Bone Density DEXA App Skeleton,170155,CDM,320,RC,77081,HCPCS,Outpatient,,,324,226.8,,259.2,80,,207.36,percent of total Billed Charges,80% of Total Billed Charges,204.12,63,,163.296,percent of total Billed charges,63% of Total Billed Charges,200.88,62,,160.704,percent of total Billed Charges,62% of total BIlled charges,204.12,63,,163.296,percent of total Billed Charges,63% of total Billed Charges,275.4,85,,220.32,percent of total Billed Charges,85% of total Billed Charges,259.2,80,,207.36,percent of total Billed Charges,80% of total Billed Charges,200.88,62,,160.704,percent of total Billed Charges,62% of total Billed Charges,204.12,63,,163.296,percent of total Billed Charges,63% of total Billed Charges,200.88,62,,160.704,percent of total Billed Charges,62% of total Billed Charges,204.12,63,,163.296,percent of total billed charges,63% of total Billed Charges,200.88,62,,160.704,percent of total Billed Charges,62% of total Billed Charges,259.2,80,,207.36,percent of total Billed Charges,80% of Total Billed Charges,200.88,62,,160.704,percent of total Billed Charges,62% of total Billed Charges,200.88,62,,160.704,percent of total Billed Charges,62% of total Billed Charges,200.88,275.4,
77080 - BD Bone Density DEXA Axial Skeleton,170154,CDM,320,RC,77080,HCPCS,Outpatient,,,436,305.2,,348.8,80,,279.04,percent of total Billed Charges,80% of Total Billed Charges,274.68,63,,219.744,percent of total Billed charges,63% of Total Billed Charges,270.32,62,,216.256,percent of total Billed Charges,62% of total BIlled charges,274.68,63,,219.744,percent of total Billed Charges,63% of total Billed Charges,370.6,85,,296.48,percent of total Billed Charges,85% of total Billed Charges,348.8,80,,279.04,percent of total Billed Charges,80% of total Billed Charges,270.32,62,,216.256,percent of total Billed Charges,62% of total Billed Charges,274.68,63,,219.744,percent of total Billed Charges,63% of total Billed Charges,270.32,62,,216.256,percent of total Billed Charges,62% of total Billed Charges,274.68,63,,219.744,percent of total billed charges,63% of total Billed Charges,270.32,62,,216.256,percent of total Billed Charges,62% of total Billed Charges,348.8,80,,279.04,percent of total Billed Charges,80% of Total Billed Charges,270.32,62,,216.256,percent of total Billed Charges,62% of total Billed Charges,270.32,62,,216.256,percent of total Billed Charges,62% of total Billed Charges,270.32,370.6,
73050 - XR AC Joints Bilateral,170120,CDM,320,RC,73050,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
74019 - XR Abdomen 2 Views,170001,CDM,320,RC,74019,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
74018 - XR Abdomen KUB 1 View,170004,CDM,320,RC,74018,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
74022 - XR Abdomen Series + Chest 1 View,170148,CDM,320,RC,74022,HCPCS,Outpatient,,,343,240.1,,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,216.09,63,,172.872,percent of total Billed charges,63% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total BIlled charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,291.55,85,,233.24,percent of total Billed Charges,85% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total billed charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,291.55,
73600 - XR Ankle 2 Views Left,170006,CDM,320,RC,73600,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73600 - XR Ankle 2 Views Right,170006,CDM,320,RC,73600,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73610 - XR Ankle Complete 3+ Views Left,170007,CDM,320,RC,73610,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73610 - XR Ankle Complete 3+ Views Right,170007,CDM,320,RC,73610,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
77072 - XR Bone Age Studies,170147,CDM,320,RC,77072,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73650 - XR Calcaneus Left,170125,CDM,320,RC,73650,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73650 - XR Calcaneus Right,170125,CDM,320,RC,73650,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73000 - XR Clavicle Left,170021,CDM,320,RC,73000,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73000 - XR Clavicle Right,170021,CDM,320,RC,73000,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73070 - XR Elbow 2 Views Left,170028,CDM,320,RC,73070,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73070 - XR Elbow 2 Views Right,170028,CDM,320,RC,73070,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73080 - XR Elbow Complete 3+ Views Left,170029,CDM,320,RC,73080,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73080 - XR Elbow Complete 3+ Views Right,170029,CDM,320,RC,73080,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
70150 - XR Facial Bones 3+ Views,170033,CDM,320,RC,70150,HCPCS,Outpatient,,,343,240.1,,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,216.09,63,,172.872,percent of total Billed charges,63% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total BIlled charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,291.55,85,,233.24,percent of total Billed Charges,85% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total billed charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,291.55,
70140 - XR Facial Bones < 3 Views,170032,CDM,320,RC,70140,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73552 - XR Femur 2 Views Left,170036,CDM,320,RC,73552,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73552 - XR Femur 2 Views Right,170036,CDM,320,RC,73552,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73140 - XR Finger(s) 2+ Views Left,170038,CDM,320,RC,73140,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73140 - XR Finger(s) 2+ Views Right,170038,CDM,320,RC,73140,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73620 - XR Foot 2 Views Left,170042,CDM,320,RC,73620,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73620 - XR Foot 2 Views Right,170042,CDM,320,RC,73620,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73630 - XR Foot Complete 3+ Views Left,170124,CDM,320,RC,73630,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73630 - XR Foot Complete 3+ Views Right,170124,CDM,320,RC,73630,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73090 - XR Forearm 2 Views Left,170044,CDM,320,RC,73090,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73090 - XR Forearm 2 Views Right,170044,CDM,320,RC,73090,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
76010 - XR Foreign Body Localization Child 1 Vw,170150,CDM,320,RC,76010,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73120 - XR Hand 2 Views Left,170054,CDM,320,RC,73120,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73120 - XR Hand 2 Views Right,170054,CDM,320,RC,73120,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73130 - XR Hand Complete 3+ Views Left,170128,CDM,320,RC,73130,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73130 - XR Hand Complete 3+ Views Right,170128,CDM,320,RC,73130,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73501 - XR Hip 1 View Left,170055,CDM,320,RC,73501,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73501 - XR Hip 1 View Right,170055,CDM,320,RC,73501,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73502 - XR Hip 2-3 Views Left,170121,CDM,320,RC,73502,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73502 - XR Hip 2-3 Views Right,170121,CDM,320,RC,73502,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73521 - XR Hips 2 Views w/AP Pelvis Bilat,170080,CDM,320,RC,73521,HCPCS,Outpatient,,,278,194.6,,222.4,80,,177.92,percent of total Billed Charges,80% of Total Billed Charges,175.14,63,,140.112,percent of total Billed charges,63% of Total Billed Charges,172.36,62,,137.888,percent of total Billed Charges,62% of total BIlled charges,175.14,63,,140.112,percent of total Billed Charges,63% of total Billed Charges,236.3,85,,189.04,percent of total Billed Charges,85% of total Billed Charges,222.4,80,,177.92,percent of total Billed Charges,80% of total Billed Charges,172.36,62,,137.888,percent of total Billed Charges,62% of total Billed Charges,175.14,63,,140.112,percent of total Billed Charges,63% of total Billed Charges,172.36,62,,137.888,percent of total Billed Charges,62% of total Billed Charges,175.14,63,,140.112,percent of total billed charges,63% of total Billed Charges,172.36,62,,137.888,percent of total Billed Charges,62% of total Billed Charges,222.4,80,,177.92,percent of total Billed Charges,80% of Total Billed Charges,172.36,62,,137.888,percent of total Billed Charges,62% of total Billed Charges,172.36,62,,137.888,percent of total Billed Charges,62% of total Billed Charges,172.36,236.3,
73060 - XR Humerus Left,170058,CDM,320,RC,73060,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73060 - XR Humerus Right,170058,CDM,320,RC,73060,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73560 - XR Knee 1 or 2 Views Left,170066,CDM,320,RC,73560,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73560 - XR Knee 1 or 2 Views Right,170066,CDM,320,RC,73560,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73562 - XR Knee 3 Views Left,170067,CDM,320,RC,73562,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73562 - XR Knee 3 Views Right,170067,CDM,320,RC,73562,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73564 - XR Knee Complete 4+ Views Left,170122,CDM,320,RC,73564,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73564 - XR Knee Complete 4+ Views Right,170122,CDM,320,RC,73564,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
70110 - XR Mandible Complete 4+ Views,170075,CDM,320,RC,70110,HCPCS,Outpatient,,,343,240.1,,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,216.09,63,,172.872,percent of total Billed charges,63% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total BIlled charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,291.55,85,,233.24,percent of total Billed Charges,85% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total billed charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,291.55,
70100 - XR Mandible Less Than 4 Views,170074,CDM,320,RC,70100,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
70160 - XR Nasal Bones 3+ Views,170077,CDM,320,RC,70160,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
70360 - XR Neck Soft Tissue,170101,CDM,320,RC,70360,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
72170 - XR Pelvis 1 or 2 Views,170079,CDM,320,RC,72170,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
71100 - XR Ribs 2 Views Left,170085,CDM,320,RC,71100,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
71100 - XR Ribs 2 Views Right,170085,CDM,320,RC,71100,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
71111 - XR Ribs w/ PA Chest Bilateral,170114,CDM,320,RC,71111,HCPCS,Outpatient,,,343,240.1,,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,216.09,63,,172.872,percent of total Billed charges,63% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total BIlled charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,291.55,85,,233.24,percent of total Billed Charges,85% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total billed charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,291.55,
71101 - XR Ribs w/ PA Chest Left,170113,CDM,320,RC,71101,HCPCS,Outpatient,,,343,240.1,,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,216.09,63,,172.872,percent of total Billed charges,63% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total BIlled charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,291.55,85,,233.24,percent of total Billed Charges,85% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total billed charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,291.55,
71101 - XR Ribs w/ PA Chest Right,170113,CDM,320,RC,71101,HCPCS,Outpatient,,,343,240.1,,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,216.09,63,,172.872,percent of total Billed charges,63% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total BIlled charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,291.55,85,,233.24,percent of total Billed Charges,85% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total billed charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,291.55,
72200 - XR Sacroiliac Joints 1 or 2 Views,170087,CDM,320,RC,72200,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
72220 - XR Sacrum/Coccyx 2+ Views,170086,CDM,320,RC,72220,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73010 - XR Scapula Left,170088,CDM,320,RC,73010,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73010 - XR Scapula Right,170088,CDM,320,RC,73010,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73020 - XR Shoulder 1 View Left,170089,CDM,320,RC,73020,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73020 - XR Shoulder 1 View Right,170089,CDM,320,RC,73020,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73030 - XR Shoulder Complete 2+ Views Left,170119,CDM,320,RC,73030,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73030 - XR Shoulder Complete 2+ Views Right,170119,CDM,320,RC,73030,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
70210 - XR Sinuses Paranasal < 3 Views,170090,CDM,320,RC,70210,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
70220 - XR Sinuses Paranasal Complete,170134,CDM,320,RC,70220,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
70250 - XR Skull < 4 Views,170092,CDM,320,RC,70250,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
70260 - XR Skull Complete,170093,CDM,320,RC,70260,HCPCS,Outpatient,,,343,240.1,,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,216.09,63,,172.872,percent of total Billed charges,63% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total BIlled charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,291.55,85,,233.24,percent of total Billed Charges,85% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total billed charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,291.55,
72020 - XR Spine Cervical 1 View,170014,CDM,320,RC,72020,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
72040 - XR Spine Cervical 2 or 3 Views,170015,CDM,320,RC,72040,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
72050 - XR Spine Cervical 4 or 5 Views,170016,CDM,320,RC,72050,HCPCS,Outpatient,,,343,240.1,,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,216.09,63,,172.872,percent of total Billed charges,63% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total BIlled charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,291.55,85,,233.24,percent of total Billed Charges,85% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total billed charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,291.55,
72052 - XR Spine Cervical 6+ Views,170115,CDM,320,RC,72052,HCPCS,Outpatient,,,343,240.1,,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,216.09,63,,172.872,percent of total Billed charges,63% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total BIlled charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,291.55,85,,233.24,percent of total Billed Charges,85% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total billed charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,291.55,
72020 - XR Spine Lumbar 1 View,170073,CDM,320,RC,72020,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
72100 - XR Spine Lumbosacral 2 or 3 Views,170071,CDM,320,RC,72100,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
72110 - XR Spine Lumbosacral 4+ Views,170072,CDM,320,RC,72110,HCPCS,Outpatient,,,343,240.1,,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,216.09,63,,172.872,percent of total Billed charges,63% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total BIlled charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,291.55,85,,233.24,percent of total Billed Charges,85% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total billed charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,291.55,
72114 - XR Spine Lumbosacral w/ Bending 6+ Views,170151,CDM,320,RC,72114,HCPCS,Outpatient,,,343,240.1,,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,216.09,63,,172.872,percent of total Billed charges,63% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total BIlled charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,291.55,85,,233.24,percent of total Billed Charges,85% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total billed charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,291.55,
72020 - XR Spine Thoracic 1 View,170145,CDM,320,RC,72020,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
72070 - XR Spine Thoracic 2 Views,170025,CDM,320,RC,72070,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
72072 - XR Spine Thoracic 3 Views,170026,CDM,320,RC,72072,HCPCS,Outpatient,,,343,240.1,,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,216.09,63,,172.872,percent of total Billed charges,63% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total BIlled charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,291.55,85,,233.24,percent of total Billed Charges,85% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total Billed Charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,216.09,63,,172.872,percent of total billed charges,63% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,274.4,80,,219.52,percent of total Billed Charges,80% of Total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,62,,170.128,percent of total Billed Charges,62% of total Billed Charges,212.66,291.55,
71120 - XR Sternum 2+ Views,170094,CDM,320,RC,71120,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
70330 - XR TMJ Open and Closed Bilateral,170098,CDM,320,RC,70330,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
70328 - XR TMJ Open and Closed Left,170096,CDM,320,RC,70328,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
70328 - XR TMJ Open and Closed Right,170096,CDM,320,RC,70328,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73590 - XR Tibia/Fibula Left,170070,CDM,320,RC,73590,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73590 - XR Tibia/Fibula Right,170070,CDM,320,RC,73590,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73660 - XR Toe(s) 2+ Views Left,170097,CDM,320,RC,73660,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73660 - XR Toe(s) 2+ Views Right,170097,CDM,320,RC,73660,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73100 - XR Wrist 2 Views Left,170102,CDM,320,RC,73100,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73100 - XR Wrist 2 Views Right,170102,CDM,320,RC,73100,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73110 - XR Wrist Complete 3+ Views Left,170103,CDM,320,RC,73110,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
73110 - XR Wrist Complete 3+ Views Right,170103,CDM,320,RC,73110,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
71045 - XR Chest 1 View,170017,CDM,324,RC,71045,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
71046 - XR Chest 2 Views,170018,CDM,324,RC,71046,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
71047 - XR Chest 3 Views,170112,CDM,324,RC,71047,HCPCS,Outpatient,,,186,130.2,,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,117.18,63,,93.744,percent of total Billed charges,63% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total BIlled charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,158.1,85,,126.48,percent of total Billed Charges,85% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total Billed Charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,117.18,63,,93.744,percent of total billed charges,63% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,148.8,80,,119.04,percent of total Billed Charges,80% of Total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,62,,92.256,percent of total Billed Charges,62% of total Billed Charges,115.32,158.1,
70496 - CT Angio Brain/Head,200055,CDM,351,RC,70496,HCPCS,Outpatient,,,2223,1556.1,,1778.4,80,,1422.72,percent of total Billed Charges,80% of Total Billed Charges,1400.49,63,,1120.392,percent of total Billed charges,63% of Total Billed Charges,1378.26,62,,1102.608,percent of total Billed Charges,62% of total BIlled charges,1400.49,63,,1120.392,percent of total Billed Charges,63% of total Billed Charges,1889.55,85,,1511.64,percent of total Billed Charges,85% of total Billed Charges,1778.4,80,,1422.72,percent of total Billed Charges,80% of total Billed Charges,1378.26,62,,1102.608,percent of total Billed Charges,62% of total Billed Charges,1400.49,63,,1120.392,percent of total Billed Charges,63% of total Billed Charges,1378.26,62,,1102.608,percent of total Billed Charges,62% of total Billed Charges,1400.49,63,,1120.392,percent of total billed charges,63% of total Billed Charges,1378.26,62,,1102.608,percent of total Billed Charges,62% of total Billed Charges,1778.4,80,,1422.72,percent of total Billed Charges,80% of Total Billed Charges,1378.26,62,,1102.608,percent of total Billed Charges,62% of total Billed Charges,1378.26,62,,1102.608,percent of total Billed Charges,62% of total Billed Charges,1378.26,1889.55,
70498 - CT Angio Neck,200052,CDM,351,RC,70498,HCPCS,Outpatient,,,1265,885.5,,1012,80,,809.6,percent of total Billed Charges,80% of Total Billed Charges,796.95,63,,637.56,percent of total Billed charges,63% of Total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total BIlled charges,796.95,63,,637.56,percent of total Billed Charges,63% of total Billed Charges,1075.25,85,,860.2,percent of total Billed Charges,85% of total Billed Charges,1012,80,,809.6,percent of total Billed Charges,80% of total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total Billed Charges,796.95,63,,637.56,percent of total Billed Charges,63% of total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total Billed Charges,796.95,63,,637.56,percent of total billed charges,63% of total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total Billed Charges,1012,80,,809.6,percent of total Billed Charges,80% of Total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total Billed Charges,784.3,1075.25,
70450 - CT Brain/Head Stroke Alert,200001,CDM,351,RC,70450,HCPCS,Outpatient,,,646,452.2,,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,406.98,63,,325.584,percent of total Billed charges,63% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total BIlled charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,549.1,85,,439.28,percent of total Billed Charges,85% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total billed charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,549.1,
70470 - CT Head w/ + w/o Contrast,200015,CDM,351,RC,70470,HCPCS,Outpatient,,,1430,1001,,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,900.9,63,,720.72,percent of total Billed charges,63% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total BIlled charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,1215.5,85,,972.4,percent of total Billed Charges,85% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total billed charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,1215.5,
70460 - CT Head w/ Contrast,200002,CDM,351,RC,70460,HCPCS,Outpatient,,,1270,889,,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,800.1,63,,640.08,percent of total Billed charges,63% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total BIlled charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,1079.5,85,,863.6,percent of total Billed Charges,85% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total billed charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,1079.5,
70450 - CT Head w/o Contrast,200001,CDM,351,RC,70450,HCPCS,Outpatient,,,646,452.2,,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,406.98,63,,325.584,percent of total Billed charges,63% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total BIlled charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,549.1,85,,439.28,percent of total Billed Charges,85% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total billed charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,549.1,
70482 - CT IAC w/ + w/o Contrast,200040,CDM,351,RC,70482,HCPCS,Outpatient,,,1430,1001,,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,900.9,63,,720.72,percent of total Billed charges,63% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total BIlled charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,1215.5,85,,972.4,percent of total Billed Charges,85% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total billed charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,1215.5,
70481 - CT IAC w/ Contrast,200039,CDM,351,RC,70481,HCPCS,Outpatient,,,1270,889,,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,800.1,63,,640.08,percent of total Billed charges,63% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total BIlled charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,1079.5,85,,863.6,percent of total Billed Charges,85% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total billed charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,1079.5,
70480 - CT IAC w/o Contrast,200004,CDM,351,RC,70480,HCPCS,Outpatient,,,646,452.2,,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,406.98,63,,325.584,percent of total Billed charges,63% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total BIlled charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,549.1,85,,439.28,percent of total Billed Charges,85% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total billed charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,549.1,
70488 - CT Maxillofacial w/ + w/o Contrast,200037,CDM,351,RC,70488,HCPCS,Outpatient,,,1430,1001,,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,900.9,63,,720.72,percent of total Billed charges,63% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total BIlled charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,1215.5,85,,972.4,percent of total Billed Charges,85% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total billed charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,1215.5,
70487 - CT Maxillofacial w/ Contrast,200036,CDM,351,RC,70487,HCPCS,Outpatient,,,1270,889,,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,800.1,63,,640.08,percent of total Billed charges,63% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total BIlled charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,1079.5,85,,863.6,percent of total Billed Charges,85% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total billed charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,1079.5,
70486 - CT Maxillofacial w/o Contrast,200029,CDM,351,RC,70486,HCPCS,Outpatient,,,646,452.2,,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,406.98,63,,325.584,percent of total Billed charges,63% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total BIlled charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,549.1,85,,439.28,percent of total Billed Charges,85% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total billed charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,549.1,
70492 - CT Neck Soft Tissue w/ + w/o Contrast,200032,CDM,351,RC,70492,HCPCS,Outpatient,,,1430,1001,,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,900.9,63,,720.72,percent of total Billed charges,63% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total BIlled charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,1215.5,85,,972.4,percent of total Billed Charges,85% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total billed charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,1215.5,
70491 - CT Neck Soft Tissue w/ Contrast,200031,CDM,351,RC,70491,HCPCS,Outpatient,,,1270,889,,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,800.1,63,,640.08,percent of total Billed charges,63% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total BIlled charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,1079.5,85,,863.6,percent of total Billed Charges,85% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total billed charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,1079.5,
70490 - CT Neck Soft Tissue w/o Contrast,200030,CDM,351,RC,70490,HCPCS,Outpatient,,,646,452.2,,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,406.98,63,,325.584,percent of total Billed charges,63% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total BIlled charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,549.1,85,,439.28,percent of total Billed Charges,85% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total billed charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,549.1,
70486 - CT Sinus w/o Contrast,200029,CDM,351,RC,70486,HCPCS,Outpatient,,,646,452.2,,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,406.98,63,,325.584,percent of total Billed charges,63% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total BIlled charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,549.1,85,,439.28,percent of total Billed Charges,85% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total billed charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,549.1,
74178 - CT Abdomen and Pelvis w/ + w/o Contrast,200048,CDM,352,RC,74178,HCPCS,Outpatient,,,1990,1393,,1592,80,,1273.6,percent of total Billed Charges,80% of Total Billed Charges,1253.7,63,,1002.96,percent of total Billed charges,63% of Total Billed Charges,1233.8,62,,987.04,percent of total Billed Charges,62% of total BIlled charges,1253.7,63,,1002.96,percent of total Billed Charges,63% of total Billed Charges,1691.5,85,,1353.2,percent of total Billed Charges,85% of total Billed Charges,1592,80,,1273.6,percent of total Billed Charges,80% of total Billed Charges,1233.8,62,,987.04,percent of total Billed Charges,62% of total Billed Charges,1253.7,63,,1002.96,percent of total Billed Charges,63% of total Billed Charges,1233.8,62,,987.04,percent of total Billed Charges,62% of total Billed Charges,1253.7,63,,1002.96,percent of total billed charges,63% of total Billed Charges,1233.8,62,,987.04,percent of total Billed Charges,62% of total Billed Charges,1592,80,,1273.6,percent of total Billed Charges,80% of Total Billed Charges,1233.8,62,,987.04,percent of total Billed Charges,62% of total Billed Charges,1233.8,62,,987.04,percent of total Billed Charges,62% of total Billed Charges,1233.8,1691.5,
74177 - CT Abdomen and Pelvis w/ Contrast,200047,CDM,352,RC,74177,HCPCS,Outpatient,,,1990,1393,,1592,80,,1273.6,percent of total Billed Charges,80% of Total Billed Charges,1253.7,63,,1002.96,percent of total Billed charges,63% of Total Billed Charges,1233.8,62,,987.04,percent of total Billed Charges,62% of total BIlled charges,1253.7,63,,1002.96,percent of total Billed Charges,63% of total Billed Charges,1691.5,85,,1353.2,percent of total Billed Charges,85% of total Billed Charges,1592,80,,1273.6,percent of total Billed Charges,80% of total Billed Charges,1233.8,62,,987.04,percent of total Billed Charges,62% of total Billed Charges,1253.7,63,,1002.96,percent of total Billed Charges,63% of total Billed Charges,1233.8,62,,987.04,percent of total Billed Charges,62% of total Billed Charges,1253.7,63,,1002.96,percent of total billed charges,63% of total Billed Charges,1233.8,62,,987.04,percent of total Billed Charges,62% of total Billed Charges,1592,80,,1273.6,percent of total Billed Charges,80% of Total Billed Charges,1233.8,62,,987.04,percent of total Billed Charges,62% of total Billed Charges,1233.8,62,,987.04,percent of total Billed Charges,62% of total Billed Charges,1233.8,1691.5,
74176 - CT Abdomen and Pelvis w/o Contrast,200046,CDM,352,RC,74176,HCPCS,Outpatient,,,1233,863.1,,986.4,80,,789.12,percent of total Billed Charges,80% of Total Billed Charges,776.79,63,,621.432,percent of total Billed charges,63% of Total Billed Charges,764.46,62,,611.568,percent of total Billed Charges,62% of total BIlled charges,776.79,63,,621.432,percent of total Billed Charges,63% of total Billed Charges,1048.05,85,,838.44,percent of total Billed Charges,85% of total Billed Charges,986.4,80,,789.12,percent of total Billed Charges,80% of total Billed Charges,764.46,62,,611.568,percent of total Billed Charges,62% of total Billed Charges,776.79,63,,621.432,percent of total Billed Charges,63% of total Billed Charges,764.46,62,,611.568,percent of total Billed Charges,62% of total Billed Charges,776.79,63,,621.432,percent of total billed charges,63% of total Billed Charges,764.46,62,,611.568,percent of total Billed Charges,62% of total Billed Charges,986.4,80,,789.12,percent of total Billed Charges,80% of Total Billed Charges,764.46,62,,611.568,percent of total Billed Charges,62% of total Billed Charges,764.46,62,,611.568,percent of total Billed Charges,62% of total Billed Charges,764.46,1048.05,
74170 - CT Abdomen w/ + w/o Contrast,200008,CDM,352,RC,74170,HCPCS,Outpatient,,,1430,1001,,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,900.9,63,,720.72,percent of total Billed charges,63% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total BIlled charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,1215.5,85,,972.4,percent of total Billed Charges,85% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total billed charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,1215.5,
74160 - CT Abdomen w/ Contrast,200003,CDM,352,RC,74160,HCPCS,Outpatient,,,1270,889,,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,800.1,63,,640.08,percent of total Billed charges,63% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total BIlled charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,1079.5,85,,863.6,percent of total Billed Charges,85% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total billed charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,1079.5,
74150 - CT Abdomen w/o Contrast,200006,CDM,352,RC,74150,HCPCS,Outpatient,,,646,452.2,,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,406.98,63,,325.584,percent of total Billed charges,63% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total BIlled charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,549.1,85,,439.28,percent of total Billed Charges,85% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total billed charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,549.1,
74175 - CT Angio Abdomen,200041,CDM,352,RC,74175,HCPCS,Outpatient,,,1265,885.5,,1012,80,,809.6,percent of total Billed Charges,80% of Total Billed Charges,796.95,63,,637.56,percent of total Billed charges,63% of Total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total BIlled charges,796.95,63,,637.56,percent of total Billed Charges,63% of total Billed Charges,1075.25,85,,860.2,percent of total Billed Charges,85% of total Billed Charges,1012,80,,809.6,percent of total Billed Charges,80% of total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total Billed Charges,796.95,63,,637.56,percent of total Billed Charges,63% of total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total Billed Charges,796.95,63,,637.56,percent of total billed charges,63% of total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total Billed Charges,1012,80,,809.6,percent of total Billed Charges,80% of Total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total Billed Charges,784.3,1075.25,
74174 - CT Angio Abdomen and Pelvis,200053,CDM,352,RC,74174,HCPCS,Outpatient,,,1841,1288.7,,1472.8,80,,1178.24,percent of total Billed Charges,80% of Total Billed Charges,1159.83,63,,927.864,percent of total Billed charges,63% of Total Billed Charges,1141.42,62,,913.136,percent of total Billed Charges,62% of total BIlled charges,1159.83,63,,927.864,percent of total Billed Charges,63% of total Billed Charges,1564.85,85,,1251.88,percent of total Billed Charges,85% of total Billed Charges,1472.8,80,,1178.24,percent of total Billed Charges,80% of total Billed Charges,1141.42,62,,913.136,percent of total Billed Charges,62% of total Billed Charges,1159.83,63,,927.864,percent of total Billed Charges,63% of total Billed Charges,1141.42,62,,913.136,percent of total Billed Charges,62% of total Billed Charges,1159.83,63,,927.864,percent of total billed charges,63% of total Billed Charges,1141.42,62,,913.136,percent of total Billed Charges,62% of total Billed Charges,1472.8,80,,1178.24,percent of total Billed Charges,80% of Total Billed Charges,1141.42,62,,913.136,percent of total Billed Charges,62% of total Billed Charges,1141.42,62,,913.136,percent of total Billed Charges,62% of total Billed Charges,1141.42,1564.85,
75635 - CT Angio Abdominal Aorta with Runoff,200049,CDM,352,RC,75635,HCPCS,Outpatient,,,1265,885.5,,1012,80,,809.6,percent of total Billed Charges,80% of Total Billed Charges,796.95,63,,637.56,percent of total Billed charges,63% of Total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total BIlled charges,796.95,63,,637.56,percent of total Billed Charges,63% of total Billed Charges,1075.25,85,,860.2,percent of total Billed Charges,85% of total Billed Charges,1012,80,,809.6,percent of total Billed Charges,80% of total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total Billed Charges,796.95,63,,637.56,percent of total Billed Charges,63% of total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total Billed Charges,796.95,63,,637.56,percent of total billed charges,63% of total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total Billed Charges,1012,80,,809.6,percent of total Billed Charges,80% of Total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total Billed Charges,784.3,1075.25,
71275 - CT Angio Chest PE Protocol,200033,CDM,352,RC,71275,HCPCS,Outpatient,,,1489,1042.3,,1191.2,80,,952.96,percent of total Billed Charges,80% of Total Billed Charges,938.07,63,,750.456,percent of total Billed charges,63% of Total Billed Charges,923.18,62,,738.544,percent of total Billed Charges,62% of total BIlled charges,938.07,63,,750.456,percent of total Billed Charges,63% of total Billed Charges,1265.65,85,,1012.52,percent of total Billed Charges,85% of total Billed Charges,1191.2,80,,952.96,percent of total Billed Charges,80% of total Billed Charges,923.18,62,,738.544,percent of total Billed Charges,62% of total Billed Charges,938.07,63,,750.456,percent of total Billed Charges,63% of total Billed Charges,923.18,62,,738.544,percent of total Billed Charges,62% of total Billed Charges,938.07,63,,750.456,percent of total billed charges,63% of total Billed Charges,923.18,62,,738.544,percent of total Billed Charges,62% of total Billed Charges,1191.2,80,,952.96,percent of total Billed Charges,80% of Total Billed Charges,923.18,62,,738.544,percent of total Billed Charges,62% of total Billed Charges,923.18,62,,738.544,percent of total Billed Charges,62% of total Billed Charges,923.18,1265.65,
73706 - CT Angio Lower Extremity Bilateral,200050,CDM,352,RC,73706,HCPCS,Outpatient,,,1265,885.5,,1012,80,,809.6,percent of total Billed Charges,80% of Total Billed Charges,796.95,63,,637.56,percent of total Billed charges,63% of Total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total BIlled charges,796.95,63,,637.56,percent of total Billed Charges,63% of total Billed Charges,1075.25,85,,860.2,percent of total Billed Charges,85% of total Billed Charges,1012,80,,809.6,percent of total Billed Charges,80% of total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total Billed Charges,796.95,63,,637.56,percent of total Billed Charges,63% of total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total Billed Charges,796.95,63,,637.56,percent of total billed charges,63% of total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total Billed Charges,1012,80,,809.6,percent of total Billed Charges,80% of Total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total Billed Charges,784.3,62,,627.44,percent of total Billed Charges,62% of total Billed Charges,784.3,1075.25,
72191 - CT Angio Pelvis,200042,CDM,352,RC,72191,HCPCS,Outpatient,,,1489,1042.3,,1191.2,80,,952.96,percent of total Billed Charges,80% of Total Billed Charges,938.07,63,,750.456,percent of total Billed charges,63% of Total Billed Charges,923.18,62,,738.544,percent of total Billed Charges,62% of total BIlled charges,938.07,63,,750.456,percent of total Billed Charges,63% of total Billed Charges,1265.65,85,,1012.52,percent of total Billed Charges,85% of total Billed Charges,1191.2,80,,952.96,percent of total Billed Charges,80% of total Billed Charges,923.18,62,,738.544,percent of total Billed Charges,62% of total Billed Charges,938.07,63,,750.456,percent of total Billed Charges,63% of total Billed Charges,923.18,62,,738.544,percent of total Billed Charges,62% of total Billed Charges,938.07,63,,750.456,percent of total billed charges,63% of total Billed Charges,923.18,62,,738.544,percent of total Billed Charges,62% of total Billed Charges,1191.2,80,,952.96,percent of total Billed Charges,80% of Total Billed Charges,923.18,62,,738.544,percent of total Billed Charges,62% of total Billed Charges,923.18,62,,738.544,percent of total Billed Charges,62% of total Billed Charges,923.18,1265.65,
71270 - CT Chest w/ + w/o Contrast,200018,CDM,352,RC,71270,HCPCS,Outpatient,,,1430,1001,,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,900.9,63,,720.72,percent of total Billed charges,63% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total BIlled charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,1215.5,85,,972.4,percent of total Billed Charges,85% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total billed charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,1215.5,
71260 - CT Chest w/ Contrast,200017,CDM,352,RC,71260,HCPCS,Outpatient,,,1270,889,,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,800.1,63,,640.08,percent of total Billed charges,63% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total BIlled charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,1079.5,85,,863.6,percent of total Billed Charges,85% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total billed charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,1079.5,
71250 - CT Chest w/o Contrast,200005,CDM,352,RC,71250,HCPCS,Outpatient,,,646,452.2,,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,406.98,63,,325.584,percent of total Billed charges,63% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total BIlled charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,549.1,85,,439.28,percent of total Billed Charges,85% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total billed charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,549.1,
76380 - CT Limited or Localized F/U Study,200035,CDM,352,RC,76380,HCPCS,Outpatient,,,406,284.2,,324.8,80,,259.84,percent of total Billed Charges,80% of Total Billed Charges,255.78,63,,204.624,percent of total Billed charges,63% of Total Billed Charges,251.72,62,,201.376,percent of total Billed Charges,62% of total BIlled charges,255.78,63,,204.624,percent of total Billed Charges,63% of total Billed Charges,345.1,85,,276.08,percent of total Billed Charges,85% of total Billed Charges,324.8,80,,259.84,percent of total Billed Charges,80% of total Billed Charges,251.72,62,,201.376,percent of total Billed Charges,62% of total Billed Charges,255.78,63,,204.624,percent of total Billed Charges,63% of total Billed Charges,251.72,62,,201.376,percent of total Billed Charges,62% of total Billed Charges,255.78,63,,204.624,percent of total billed charges,63% of total Billed Charges,251.72,62,,201.376,percent of total Billed Charges,62% of total Billed Charges,324.8,80,,259.84,percent of total Billed Charges,80% of Total Billed Charges,251.72,62,,201.376,percent of total Billed Charges,62% of total Billed Charges,251.72,62,,201.376,percent of total Billed Charges,62% of total Billed Charges,251.72,345.1,
71271 - CT Low Dose Lung Scan,200054,CDM,352,RC,71271,HCPCS,Outpatient,,,486,340.2,,388.8,80,,311.04,percent of total Billed Charges,80% of Total Billed Charges,306.18,63,,244.944,percent of total Billed charges,63% of Total Billed Charges,301.32,62,,241.056,percent of total Billed Charges,62% of total BIlled charges,306.18,63,,244.944,percent of total Billed Charges,63% of total Billed Charges,413.1,85,,330.48,percent of total Billed Charges,85% of total Billed Charges,388.8,80,,311.04,percent of total Billed Charges,80% of total Billed Charges,301.32,62,,241.056,percent of total Billed Charges,62% of total Billed Charges,306.18,63,,244.944,percent of total Billed Charges,63% of total Billed Charges,301.32,62,,241.056,percent of total Billed Charges,62% of total Billed Charges,306.18,63,,244.944,percent of total billed charges,63% of total Billed Charges,301.32,62,,241.056,percent of total Billed Charges,62% of total Billed Charges,388.8,80,,311.04,percent of total Billed Charges,80% of Total Billed Charges,301.32,62,,241.056,percent of total Billed Charges,62% of total Billed Charges,301.32,62,,241.056,percent of total Billed Charges,62% of total Billed Charges,301.32,413.1,
73701 - CT Lower Extremity w/ Contrast Left,200027,CDM,352,RC,73701,HCPCS,Outpatient,,,1270,889,,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,800.1,63,,640.08,percent of total Billed charges,63% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total BIlled charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,1079.5,85,,863.6,percent of total Billed Charges,85% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total billed charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,1079.5,
73701 - CT Lower Extremity w/ Contrast Right,200027,CDM,352,RC,73701,HCPCS,Outpatient,,,1270,889,,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,800.1,63,,640.08,percent of total Billed charges,63% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total BIlled charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,1079.5,85,,863.6,percent of total Billed Charges,85% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total billed charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,1079.5,
73702 - CT Lower Extremity w/+w/o Contrast Left,200028,CDM,352,RC,73702,HCPCS,Outpatient,,,1430,1001,,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,900.9,63,,720.72,percent of total Billed charges,63% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total BIlled charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,1215.5,85,,972.4,percent of total Billed Charges,85% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total billed charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,1215.5,
73702 - CT Lower Extremity w/+w/o Contrast Right,200028,CDM,352,RC,73702,HCPCS,Outpatient,,,1430,1001,,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,900.9,63,,720.72,percent of total Billed charges,63% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total BIlled charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,1215.5,85,,972.4,percent of total Billed Charges,85% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total billed charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,1215.5,
73700 - CT Lower Extremity w/o Contrast Left,200014,CDM,352,RC,73700,HCPCS,Outpatient,,,646,452.2,,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,406.98,63,,325.584,percent of total Billed charges,63% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total BIlled charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,549.1,85,,439.28,percent of total Billed Charges,85% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total billed charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,549.1,
73700 - CT Lower Extremity w/o Contrast Right,200014,CDM,352,RC,73700,HCPCS,Outpatient,,,646,452.2,,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,406.98,63,,325.584,percent of total Billed charges,63% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total BIlled charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,549.1,85,,439.28,percent of total Billed Charges,85% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total billed charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,549.1,
72194 - CT Pelvis w/ + w/o Contrast,200026,CDM,352,RC,72194,HCPCS,Outpatient,,,1430,1001,,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,900.9,63,,720.72,percent of total Billed charges,63% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total BIlled charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,1215.5,85,,972.4,percent of total Billed Charges,85% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total billed charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,1215.5,
72193 - CT Pelvis w/ Contrast,200007,CDM,352,RC,72193,HCPCS,Outpatient,,,1270,889,,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,800.1,63,,640.08,percent of total Billed charges,63% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total BIlled charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,1079.5,85,,863.6,percent of total Billed Charges,85% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total billed charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,1079.5,
72192 - CT Pelvis w/o Contrast,200025,CDM,352,RC,72192,HCPCS,Outpatient,,,646,452.2,,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,406.98,63,,325.584,percent of total Billed charges,63% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total BIlled charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,549.1,85,,439.28,percent of total Billed Charges,85% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total billed charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,549.1,
72127 - CT Spine Cervical w/ + w/o Contrast,200020,CDM,352,RC,72127,HCPCS,Outpatient,,,1430,1001,,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,900.9,63,,720.72,percent of total Billed charges,63% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total BIlled charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,1215.5,85,,972.4,percent of total Billed Charges,85% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total billed charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,1215.5,
72126 - CT Spine Cervical w/ Contrast,200019,CDM,352,RC,72126,HCPCS,Outpatient,,,1270,889,,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,800.1,63,,640.08,percent of total Billed charges,63% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total BIlled charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,1079.5,85,,863.6,percent of total Billed Charges,85% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total billed charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,1079.5,
72125 - CT Spine Cervical w/o Contrast,200009,CDM,352,RC,72125,HCPCS,Outpatient,,,646,452.2,,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,406.98,63,,325.584,percent of total Billed charges,63% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total BIlled charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,549.1,85,,439.28,percent of total Billed Charges,85% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total billed charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,549.1,
72133 - CT Spine Lumbar w/ + w/o Contrast,200024,CDM,352,RC,72133,HCPCS,Outpatient,,,1430,1001,,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,900.9,63,,720.72,percent of total Billed charges,63% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total BIlled charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,1215.5,85,,972.4,percent of total Billed Charges,85% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total billed charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,1215.5,
72132 - CT Spine Lumbar w/ Contrast,200023,CDM,352,RC,72132,HCPCS,Outpatient,,,1270,889,,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,800.1,63,,640.08,percent of total Billed charges,63% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total BIlled charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,1079.5,85,,863.6,percent of total Billed Charges,85% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total billed charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,1079.5,
72131 - CT Spine Lumbar w/o Contrast,200011,CDM,352,RC,72131,HCPCS,Outpatient,,,646,452.2,,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,406.98,63,,325.584,percent of total Billed charges,63% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total BIlled charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,549.1,85,,439.28,percent of total Billed Charges,85% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total billed charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,549.1,
72130 - CT Spine Thoracic w/ + w/o Contrast,200022,CDM,352,RC,72130,HCPCS,Outpatient,,,1430,1001,,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,900.9,63,,720.72,percent of total Billed charges,63% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total BIlled charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,1215.5,85,,972.4,percent of total Billed Charges,85% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total billed charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,1215.5,
72129 - CT Spine Thoracic w/ Contrast,200021,CDM,352,RC,72129,HCPCS,Outpatient,,,1270,889,,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,800.1,63,,640.08,percent of total Billed charges,63% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total BIlled charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,1079.5,85,,863.6,percent of total Billed Charges,85% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total billed charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,1079.5,
72128 - CT Spine Thoracic w/o Contrast,200010,CDM,352,RC,72128,HCPCS,Outpatient,,,646,452.2,,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,406.98,63,,325.584,percent of total Billed charges,63% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total BIlled charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,549.1,85,,439.28,percent of total Billed Charges,85% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total billed charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,549.1,
73201 - CT Upper Extremity w/ Contrast Left,200038,CDM,352,RC,73201,HCPCS,Outpatient,,,1270,889,,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,800.1,63,,640.08,percent of total Billed charges,63% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total BIlled charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,1079.5,85,,863.6,percent of total Billed Charges,85% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total billed charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,1079.5,
73201 - CT Upper Extremity w/ Contrast Right,200038,CDM,352,RC,73201,HCPCS,Outpatient,,,1270,889,,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,800.1,63,,640.08,percent of total Billed charges,63% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total BIlled charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,1079.5,85,,863.6,percent of total Billed Charges,85% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total Billed Charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,800.1,63,,640.08,percent of total billed charges,63% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,1016,80,,812.8,percent of total Billed Charges,80% of Total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,62,,629.92,percent of total Billed Charges,62% of total Billed Charges,787.4,1079.5,
73202 - CT Upper Extremity w/+w/o Contrast Left,200013,CDM,352,RC,73202,HCPCS,Outpatient,,,1430,1001,,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,900.9,63,,720.72,percent of total Billed charges,63% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total BIlled charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,1215.5,85,,972.4,percent of total Billed Charges,85% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total billed charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,1215.5,
73202 - CT Upper Extremity w/+w/o Contrast Right,200013,CDM,352,RC,73202,HCPCS,Outpatient,,,1430,1001,,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,900.9,63,,720.72,percent of total Billed charges,63% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total BIlled charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,1215.5,85,,972.4,percent of total Billed Charges,85% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total Billed Charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,900.9,63,,720.72,percent of total billed charges,63% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,1144,80,,915.2,percent of total Billed Charges,80% of Total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,62,,709.28,percent of total Billed Charges,62% of total Billed Charges,886.6,1215.5,
73200 - CT Upper Extremity w/o Contrast Left,200016,CDM,352,RC,73200,HCPCS,Outpatient,,,646,452.2,,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,406.98,63,,325.584,percent of total Billed charges,63% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total BIlled charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,549.1,85,,439.28,percent of total Billed Charges,85% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total billed charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,549.1,
73200 - CT Upper Extremity w/o Contrast Right,200016,CDM,352,RC,73200,HCPCS,Outpatient,,,646,452.2,,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,406.98,63,,325.584,percent of total Billed charges,63% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total BIlled charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,549.1,85,,439.28,percent of total Billed Charges,85% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total Billed Charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,406.98,63,,325.584,percent of total billed charges,63% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,516.8,80,,413.44,percent of total Billed Charges,80% of Total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,62,,320.416,percent of total Billed Charges,62% of total Billed Charges,400.52,549.1,
13122 Repair Complex Scalp/Arm/Leg TechFee,536582,CDM,360,RC,13122,HCPCS,Outpatient,,,576,403.2,,460.8,80,,368.64,percent of total Billed Charges,80% of Total Billed Charges,362.88,63,,290.304,percent of total Billed charges,63% of Total Billed Charges,357.12,62,,285.696,percent of total Billed Charges,62% of total BIlled charges,362.88,63,,290.304,percent of total Billed Charges,63% of total Billed Charges,489.6,85,,391.68,percent of total Billed Charges,85% of total Billed Charges,460.8,80,,368.64,percent of total Billed Charges,80% of total Billed Charges,357.12,62,,285.696,percent of total Billed Charges,62% of total Billed Charges,362.88,63,,290.304,percent of total Billed Charges,63% of total Billed Charges,357.12,62,,285.696,percent of total Billed Charges,62% of total Billed Charges,362.88,63,,290.304,percent of total billed charges,63% of total Billed Charges,357.12,62,,285.696,percent of total Billed Charges,62% of total Billed Charges,460.8,80,,368.64,percent of total Billed Charges,80% of Total Billed Charges,357.12,62,,285.696,percent of total Billed Charges,62% of total Billed Charges,357.12,62,,285.696,percent of total Billed Charges,62% of total Billed Charges,357.12,489.6,
42830 - Adenoidectomy,542830,CDM,360,RC,42830,HCPCS,Outpatient,,,7273,5091.1,,5818.4,80,,4654.72,percent of total Billed Charges,80% of Total Billed Charges,4581.99,63,,3665.592,percent of total Billed charges,63% of Total Billed Charges,4509.26,62,,3607.408,percent of total Billed Charges,62% of total BIlled charges,4581.99,63,,3665.592,percent of total Billed Charges,63% of total Billed Charges,6182.05,85,,4945.64,percent of total Billed Charges,85% of total Billed Charges,5818.4,80,,4654.72,percent of total Billed Charges,80% of total Billed Charges,4509.26,62,,3607.408,percent of total Billed Charges,62% of total Billed Charges,4581.99,63,,3665.592,percent of total Billed Charges,63% of total Billed Charges,4509.26,62,,3607.408,percent of total Billed Charges,62% of total Billed Charges,4581.99,63,,3665.592,percent of total billed charges,63% of total Billed Charges,4509.26,62,,3607.408,percent of total Billed Charges,62% of total Billed Charges,5818.4,80,,4654.72,percent of total Billed Charges,80% of Total Billed Charges,4509.26,62,,3607.408,percent of total Billed Charges,62% of total Billed Charges,4509.26,62,,3607.408,percent of total Billed Charges,62% of total Billed Charges,4509.26,6182.05,
26952 - Amputation Finger,526952,CDM,360,RC,26952,HCPCS,Outpatient,,,2552,1786.4,,2041.6,80,,1633.28,percent of total Billed Charges,80% of Total Billed Charges,1607.76,63,,1286.208,percent of total Billed charges,63% of Total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total BIlled charges,1607.76,63,,1286.208,percent of total Billed Charges,63% of total Billed Charges,2169.2,85,,1735.36,percent of total Billed Charges,85% of total Billed Charges,2041.6,80,,1633.28,percent of total Billed Charges,80% of total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total Billed Charges,1607.76,63,,1286.208,percent of total Billed Charges,63% of total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total Billed Charges,1607.76,63,,1286.208,percent of total billed charges,63% of total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total Billed Charges,2041.6,80,,1633.28,percent of total Billed Charges,80% of Total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total Billed Charges,1582.24,2169.2,
46606 - Anoscopy Biopsy,546606,CDM,360,RC,46606,HCPCS,Outpatient,,,1873,1311.1,,1498.4,80,,1198.72,percent of total Billed Charges,80% of Total Billed Charges,1179.99,63,,943.992,percent of total Billed charges,63% of Total Billed Charges,1161.26,62,,929.008,percent of total Billed Charges,62% of total BIlled charges,1179.99,63,,943.992,percent of total Billed Charges,63% of total Billed Charges,1592.05,85,,1273.64,percent of total Billed Charges,85% of total Billed Charges,1498.4,80,,1198.72,percent of total Billed Charges,80% of total Billed Charges,1161.26,62,,929.008,percent of total Billed Charges,62% of total Billed Charges,1179.99,63,,943.992,percent of total Billed Charges,63% of total Billed Charges,1161.26,62,,929.008,percent of total Billed Charges,62% of total Billed Charges,1179.99,63,,943.992,percent of total billed charges,63% of total Billed Charges,1161.26,62,,929.008,percent of total Billed Charges,62% of total Billed Charges,1498.4,80,,1198.72,percent of total Billed Charges,80% of Total Billed Charges,1161.26,62,,929.008,percent of total Billed Charges,62% of total Billed Charges,1161.26,62,,929.008,percent of total Billed Charges,62% of total Billed Charges,1161.26,1592.05,
44950 - Appendectomy,544950,CDM,360,RC,44950,HCPCS,Outpatient,,,3747,2622.9,,2997.6,80,,2398.08,percent of total Billed Charges,80% of Total Billed Charges,2360.61,63,,1888.488,percent of total Billed charges,63% of Total Billed Charges,2323.14,62,,1858.512,percent of total Billed Charges,62% of total BIlled charges,2360.61,63,,1888.488,percent of total Billed Charges,63% of total Billed Charges,3184.95,85,,2547.96,percent of total Billed Charges,85% of total Billed Charges,2997.6,80,,2398.08,percent of total Billed Charges,80% of total Billed Charges,2323.14,62,,1858.512,percent of total Billed Charges,62% of total Billed Charges,2360.61,63,,1888.488,percent of total Billed Charges,63% of total Billed Charges,2323.14,62,,1858.512,percent of total Billed Charges,62% of total Billed Charges,2360.61,63,,1888.488,percent of total billed charges,63% of total Billed Charges,2323.14,62,,1858.512,percent of total Billed Charges,62% of total Billed Charges,2997.6,80,,2398.08,percent of total Billed Charges,80% of Total Billed Charges,2323.14,62,,1858.512,percent of total Billed Charges,62% of total Billed Charges,2323.14,62,,1858.512,percent of total Billed Charges,62% of total Billed Charges,2323.14,3184.95,
27446 - Arthroplasty Arthroscopy Knee,527446,CDM,360,RC,27446,HCPCS,Outpatient,,,19854,13897.8,,15883.2,80,,12706.56,percent of total Billed Charges,80% of Total Billed Charges,12508.02,63,,10006.416,percent of total Billed charges,63% of Total Billed Charges,12309.48,62,,9847.584,percent of total Billed Charges,62% of total BIlled charges,12508.02,63,,10006.416,percent of total Billed Charges,63% of total Billed Charges,16875.9,85,,13500.72,percent of total Billed Charges,85% of total Billed Charges,15883.2,80,,12706.56,percent of total Billed Charges,80% of total Billed Charges,12309.48,62,,9847.584,percent of total Billed Charges,62% of total Billed Charges,12508.02,63,,10006.416,percent of total Billed Charges,63% of total Billed Charges,12309.48,62,,9847.584,percent of total Billed Charges,62% of total Billed Charges,12508.02,63,,10006.416,percent of total billed charges,63% of total Billed Charges,12309.48,62,,9847.584,percent of total Billed Charges,62% of total Billed Charges,15883.2,80,,12706.56,percent of total Billed Charges,80% of Total Billed Charges,12309.48,62,,9847.584,percent of total Billed Charges,62% of total Billed Charges,12309.48,62,,9847.584,percent of total Billed Charges,62% of total Billed Charges,12309.48,16875.9,
26530 - Arthroplasty Finger,526530,CDM,360,RC,26530,HCPCS,Outpatient,,,6370,4459,,5096,80,,4076.8,percent of total Billed Charges,80% of Total Billed Charges,4013.1,63,,3210.48,percent of total Billed charges,63% of Total Billed Charges,3949.4,62,,3159.52,percent of total Billed Charges,62% of total BIlled charges,4013.1,63,,3210.48,percent of total Billed Charges,63% of total Billed Charges,5414.5,85,,4331.6,percent of total Billed Charges,85% of total Billed Charges,5096,80,,4076.8,percent of total Billed Charges,80% of total Billed Charges,3949.4,62,,3159.52,percent of total Billed Charges,62% of total Billed Charges,4013.1,63,,3210.48,percent of total Billed Charges,63% of total Billed Charges,3949.4,62,,3159.52,percent of total Billed Charges,62% of total Billed Charges,4013.1,63,,3210.48,percent of total billed charges,63% of total Billed Charges,3949.4,62,,3159.52,percent of total Billed Charges,62% of total Billed Charges,5096,80,,4076.8,percent of total Billed Charges,80% of Total Billed Charges,3949.4,62,,3159.52,percent of total Billed Charges,62% of total Billed Charges,3949.4,62,,3159.52,percent of total Billed Charges,62% of total Billed Charges,3949.4,5414.5,
28160 - Arthroplasty Toe,528160,CDM,360,RC,28160,HCPCS,Outpatient,,,3435,2404.5,,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2164.05,63,,1731.24,percent of total Billed charges,63% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total BIlled charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2919.75,85,,2335.8,percent of total Billed Charges,85% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total billed charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,2919.75,
29874 - Arthroscopy Knee with Repair Osteochondritis Dissecans,529874,CDM,360,RC,29874,HCPCS,Outpatient,,,4398,3078.6,,3518.4,80,,2814.72,percent of total Billed Charges,80% of Total Billed Charges,2770.74,63,,2216.592,percent of total Billed charges,63% of Total Billed Charges,2726.76,62,,2181.408,percent of total Billed Charges,62% of total BIlled charges,2770.74,63,,2216.592,percent of total Billed Charges,63% of total Billed Charges,3738.3,85,,2990.64,percent of total Billed Charges,85% of total Billed Charges,3518.4,80,,2814.72,percent of total Billed Charges,80% of total Billed Charges,2726.76,62,,2181.408,percent of total Billed Charges,62% of total Billed Charges,2770.74,63,,2216.592,percent of total Billed Charges,63% of total Billed Charges,2726.76,62,,2181.408,percent of total Billed Charges,62% of total Billed Charges,2770.74,63,,2216.592,percent of total billed charges,63% of total Billed Charges,2726.76,62,,2181.408,percent of total Billed Charges,62% of total Billed Charges,3518.4,80,,2814.72,percent of total Billed Charges,80% of Total Billed Charges,2726.76,62,,2181.408,percent of total Billed Charges,62% of total Billed Charges,2726.76,62,,2181.408,percent of total Billed Charges,62% of total Billed Charges,2726.76,3738.3,
24000 - Arthrotomy Elbow,524000,CDM,360,RC,24000,HCPCS,Outpatient,,,5255,3678.5,,4204,80,,3363.2,percent of total Billed Charges,80% of Total Billed Charges,3310.65,63,,2648.52,percent of total Billed charges,63% of Total Billed Charges,3258.1,62,,2606.48,percent of total Billed Charges,62% of total BIlled charges,3310.65,63,,2648.52,percent of total Billed Charges,63% of total Billed Charges,4466.75,85,,3573.4,percent of total Billed Charges,85% of total Billed Charges,4204,80,,3363.2,percent of total Billed Charges,80% of total Billed Charges,3258.1,62,,2606.48,percent of total Billed Charges,62% of total Billed Charges,3310.65,63,,2648.52,percent of total Billed Charges,63% of total Billed Charges,3258.1,62,,2606.48,percent of total Billed Charges,62% of total Billed Charges,3310.65,63,,2648.52,percent of total billed charges,63% of total Billed Charges,3258.1,62,,2606.48,percent of total Billed Charges,62% of total Billed Charges,4204,80,,3363.2,percent of total Billed Charges,80% of Total Billed Charges,3258.1,62,,2606.48,percent of total Billed Charges,62% of total Billed Charges,3258.1,62,,2606.48,percent of total Billed Charges,62% of total Billed Charges,3258.1,4466.75,
37609 - Biopsy Artery Temporal,537609,CDM,360,RC,37609,HCPCS,Outpatient,,,2339,1637.3,,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1473.57,63,,1178.856,percent of total Billed charges,63% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total BIlled charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1988.15,85,,1590.52,percent of total Billed Charges,85% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total billed charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,1988.15,
52204 - Biopsy Bladder,552204,CDM,360,RC,52204,HCPCS,Outpatient,,,4095,2866.5,,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2579.85,63,,2063.88,percent of total Billed charges,63% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total BIlled charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,3480.75,85,,2784.6,percent of total Billed Charges,85% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total billed charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,3480.75,
20225 - Biopsy Bone Lower Extremity,520225,CDM,360,RC,20225,HCPCS,Outpatient,,,2339,1637.3,,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1473.57,63,,1178.856,percent of total Billed charges,63% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total BIlled charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1988.15,85,,1590.52,percent of total Billed Charges,85% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total billed charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,1988.15,
19101 - Biopsy Breast,519101,CDM,360,RC,19101,HCPCS,Outpatient,,,4028,2819.6,,3222.4,80,,2577.92,percent of total Billed Charges,80% of Total Billed Charges,2537.64,63,,2030.112,percent of total Billed charges,63% of Total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total BIlled charges,2537.64,63,,2030.112,percent of total Billed Charges,63% of total Billed Charges,3423.8,85,,2739.04,percent of total Billed Charges,85% of total Billed Charges,3222.4,80,,2577.92,percent of total Billed Charges,80% of total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total Billed Charges,2537.64,63,,2030.112,percent of total Billed Charges,63% of total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total Billed Charges,2537.64,63,,2030.112,percent of total billed charges,63% of total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total Billed Charges,3222.4,80,,2577.92,percent of total Billed Charges,80% of Total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total Billed Charges,2497.36,3423.8,
69100 - Biopsy Ear External,569100,CDM,360,RC,69100,HCPCS,Outpatient,,,534,373.8,,427.2,80,,341.76,percent of total Billed Charges,80% of Total Billed Charges,336.42,63,,269.136,percent of total Billed charges,63% of Total Billed Charges,331.08,62,,264.864,percent of total Billed Charges,62% of total BIlled charges,336.42,63,,269.136,percent of total Billed Charges,63% of total Billed Charges,453.9,85,,363.12,percent of total Billed Charges,85% of total Billed Charges,427.2,80,,341.76,percent of total Billed Charges,80% of total Billed Charges,331.08,62,,264.864,percent of total Billed Charges,62% of total Billed Charges,336.42,63,,269.136,percent of total Billed Charges,63% of total Billed Charges,331.08,62,,264.864,percent of total Billed Charges,62% of total Billed Charges,336.42,63,,269.136,percent of total billed charges,63% of total Billed Charges,331.08,62,,264.864,percent of total Billed Charges,62% of total Billed Charges,427.2,80,,341.76,percent of total Billed Charges,80% of Total Billed Charges,331.08,62,,264.864,percent of total Billed Charges,62% of total Billed Charges,331.08,62,,264.864,percent of total Billed Charges,62% of total Billed Charges,331.08,453.9,
67810 - Biopsy Eyelid,567810,CDM,360,RC,67810,HCPCS,Outpatient,,,521,364.7,,416.8,80,,333.44,percent of total Billed Charges,80% of Total Billed Charges,328.23,63,,262.584,percent of total Billed charges,63% of Total Billed Charges,323.02,62,,258.416,percent of total Billed Charges,62% of total BIlled charges,328.23,63,,262.584,percent of total Billed Charges,63% of total Billed Charges,442.85,85,,354.28,percent of total Billed Charges,85% of total Billed Charges,416.8,80,,333.44,percent of total Billed Charges,80% of total Billed Charges,323.02,62,,258.416,percent of total Billed Charges,62% of total Billed Charges,328.23,63,,262.584,percent of total Billed Charges,63% of total Billed Charges,323.02,62,,258.416,percent of total Billed Charges,62% of total Billed Charges,328.23,63,,262.584,percent of total billed charges,63% of total Billed Charges,323.02,62,,258.416,percent of total Billed Charges,62% of total Billed Charges,416.8,80,,333.44,percent of total Billed Charges,80% of Total Billed Charges,323.02,62,,258.416,percent of total Billed Charges,62% of total Billed Charges,323.02,62,,258.416,percent of total Billed Charges,62% of total Billed Charges,323.02,442.85,
68510 - Biopsy Lacrimal Gland,568510,CDM,360,RC,68510,HCPCS,Outpatient,,,3131,2191.7,,2504.8,80,,2003.84,percent of total Billed Charges,80% of Total Billed Charges,1972.53,63,,1578.024,percent of total Billed charges,63% of Total Billed Charges,1941.22,62,,1552.976,percent of total Billed Charges,62% of total BIlled charges,1972.53,63,,1578.024,percent of total Billed Charges,63% of total Billed Charges,2661.35,85,,2129.08,percent of total Billed Charges,85% of total Billed Charges,2504.8,80,,2003.84,percent of total Billed Charges,80% of total Billed Charges,1941.22,62,,1552.976,percent of total Billed Charges,62% of total Billed Charges,1972.53,63,,1578.024,percent of total Billed Charges,63% of total Billed Charges,1941.22,62,,1552.976,percent of total Billed Charges,62% of total Billed Charges,1972.53,63,,1578.024,percent of total billed charges,63% of total Billed Charges,1941.22,62,,1552.976,percent of total Billed Charges,62% of total Billed Charges,2504.8,80,,2003.84,percent of total Billed Charges,80% of Total Billed Charges,1941.22,62,,1552.976,percent of total Billed Charges,62% of total Billed Charges,1941.22,62,,1552.976,percent of total Billed Charges,62% of total Billed Charges,1941.22,2661.35,
42804 - Biopsy Nasopharynx,542804,CDM,360,RC,42804,HCPCS,Outpatient,,,2485,1739.5,,1988,80,,1590.4,percent of total Billed Charges,80% of Total Billed Charges,1565.55,63,,1252.44,percent of total Billed charges,63% of Total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total BIlled charges,1565.55,63,,1252.44,percent of total Billed Charges,63% of total Billed Charges,2112.25,85,,1689.8,percent of total Billed Charges,85% of total Billed Charges,1988,80,,1590.4,percent of total Billed Charges,80% of total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total Billed Charges,1565.55,63,,1252.44,percent of total Billed Charges,63% of total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total Billed Charges,1565.55,63,,1252.44,percent of total billed charges,63% of total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total Billed Charges,1988,80,,1590.4,percent of total Billed Charges,80% of Total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total Billed Charges,1540.7,2112.25,
19100 - Biopsy Percutaneous Breast,519100,CDM,360,RC,19100,HCPCS,Outpatient,,,839,587.3,,671.2,80,,536.96,percent of total Billed Charges,80% of Total Billed Charges,528.57,63,,422.856,percent of total Billed charges,63% of Total Billed Charges,520.18,62,,416.144,percent of total Billed Charges,62% of total BIlled charges,528.57,63,,422.856,percent of total Billed Charges,63% of total Billed Charges,713.15,85,,570.52,percent of total Billed Charges,85% of total Billed Charges,671.2,80,,536.96,percent of total Billed Charges,80% of total Billed Charges,520.18,62,,416.144,percent of total Billed Charges,62% of total Billed Charges,528.57,63,,422.856,percent of total Billed Charges,63% of total Billed Charges,520.18,62,,416.144,percent of total Billed Charges,62% of total Billed Charges,528.57,63,,422.856,percent of total billed charges,63% of total Billed Charges,520.18,62,,416.144,percent of total Billed Charges,62% of total Billed Charges,671.2,80,,536.96,percent of total Billed Charges,80% of Total Billed Charges,520.18,62,,416.144,percent of total Billed Charges,62% of total Billed Charges,520.18,62,,416.144,percent of total Billed Charges,62% of total Billed Charges,520.18,713.15,
21550 - Biopsy Skin Head/Neck,521550,CDM,360,RC,21550,HCPCS,Outpatient,,,2339,1637.3,,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1473.57,63,,1178.856,percent of total Billed charges,63% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total BIlled charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1988.15,85,,1590.52,percent of total Billed Charges,85% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total billed charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,1988.15,
27324 - Biopsy Skin Lower Extremity,527324,CDM,360,RC,27324,HCPCS,Outpatient,,,3543,2480.1,,2834.4,80,,2267.52,percent of total Billed Charges,80% of Total Billed Charges,2232.09,63,,1785.672,percent of total Billed charges,63% of Total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total BIlled charges,2232.09,63,,1785.672,percent of total Billed Charges,63% of total Billed Charges,3011.55,85,,2409.24,percent of total Billed Charges,85% of total Billed Charges,2834.4,80,,2267.52,percent of total Billed Charges,80% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2232.09,63,,1785.672,percent of total Billed Charges,63% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2232.09,63,,1785.672,percent of total billed charges,63% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2834.4,80,,2267.52,percent of total Billed Charges,80% of Total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2196.66,3011.55,
21920 - Biopsy Skin Torso,521920,CDM,360,RC,21920,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
25065 - Biopsy Skin Upper Extremity,525065,CDM,360,RC,25065,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
27340 - Bursectomy Lower Extremity,527340,CDM,360,RC,27340,HCPCS,Outpatient,,,3345,2341.5,,2676,80,,2140.8,percent of total Billed Charges,80% of Total Billed Charges,2107.35,63,,1685.88,percent of total Billed charges,63% of Total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total BIlled charges,2107.35,63,,1685.88,percent of total Billed Charges,63% of total Billed Charges,2843.25,85,,2274.6,percent of total Billed Charges,85% of total Billed Charges,2676,80,,2140.8,percent of total Billed Charges,80% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2107.35,63,,1685.88,percent of total Billed Charges,63% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2107.35,63,,1685.88,percent of total billed charges,63% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2676,80,,2140.8,percent of total Billed Charges,80% of Total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2073.9,2843.25,
67715 - Canthotomy,567715,CDM,360,RC,67715,HCPCS,Outpatient,,,2958,2070.6,,2366.4,80,,1893.12,percent of total Billed Charges,80% of Total Billed Charges,1863.54,63,,1490.832,percent of total Billed charges,63% of Total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total BIlled charges,1863.54,63,,1490.832,percent of total Billed Charges,63% of total Billed Charges,2514.3,85,,2011.44,percent of total Billed Charges,85% of total Billed Charges,2366.4,80,,1893.12,percent of total Billed Charges,80% of total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total Billed Charges,1863.54,63,,1490.832,percent of total Billed Charges,63% of total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total Billed Charges,1863.54,63,,1490.832,percent of total billed charges,63% of total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total Billed Charges,2366.4,80,,1893.12,percent of total Billed Charges,80% of Total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total Billed Charges,1833.96,2514.3,
28270 - Capsulotomy Foot,528270,CDM,360,RC,28270,HCPCS,Outpatient,,,4880,3416,,3904,80,,3123.2,percent of total Billed Charges,80% of Total Billed Charges,3074.4,63,,2459.52,percent of total Billed charges,63% of Total Billed Charges,3025.6,62,,2420.48,percent of total Billed Charges,62% of total BIlled charges,3074.4,63,,2459.52,percent of total Billed Charges,63% of total Billed Charges,4148,85,,3318.4,percent of total Billed Charges,85% of total Billed Charges,3904,80,,3123.2,percent of total Billed Charges,80% of total Billed Charges,3025.6,62,,2420.48,percent of total Billed Charges,62% of total Billed Charges,3074.4,63,,2459.52,percent of total Billed Charges,63% of total Billed Charges,3025.6,62,,2420.48,percent of total Billed Charges,62% of total Billed Charges,3074.4,63,,2459.52,percent of total billed charges,63% of total Billed Charges,3025.6,62,,2420.48,percent of total Billed Charges,62% of total Billed Charges,3904,80,,3123.2,percent of total Billed Charges,80% of Total Billed Charges,3025.6,62,,2420.48,percent of total Billed Charges,62% of total Billed Charges,3025.6,62,,2420.48,percent of total Billed Charges,62% of total Billed Charges,3025.6,4148,
51102 - Catheterization Suprapubic Bladder,551010,CDM,360,RC,51102,HCPCS,Outpatient,,,2896,2027.2,,2316.8,80,,1853.44,percent of total Billed Charges,80% of Total Billed Charges,1824.48,63,,1459.584,percent of total Billed charges,63% of Total Billed Charges,1795.52,62,,1436.416,percent of total Billed Charges,62% of total BIlled charges,1824.48,63,,1459.584,percent of total Billed Charges,63% of total Billed Charges,2461.6,85,,1969.28,percent of total Billed Charges,85% of total Billed Charges,2316.8,80,,1853.44,percent of total Billed Charges,80% of total Billed Charges,1795.52,62,,1436.416,percent of total Billed Charges,62% of total Billed Charges,1824.48,63,,1459.584,percent of total Billed Charges,63% of total Billed Charges,1795.52,62,,1436.416,percent of total Billed Charges,62% of total Billed Charges,1824.48,63,,1459.584,percent of total billed charges,63% of total Billed Charges,1795.52,62,,1436.416,percent of total Billed Charges,62% of total Billed Charges,2316.8,80,,1853.44,percent of total Billed Charges,80% of Total Billed Charges,1795.52,62,,1436.416,percent of total Billed Charges,62% of total Billed Charges,1795.52,62,,1436.416,percent of total Billed Charges,62% of total Billed Charges,1795.52,2461.6,
47600 - Cholecystectomy,547605,CDM,360,RC,47600,HCPCS,Outpatient,,,3290,2303,,2632,80,,2105.6,percent of total Billed Charges,80% of Total Billed Charges,2072.7,63,,1658.16,percent of total Billed charges,63% of Total Billed Charges,2039.8,62,,1631.84,percent of total Billed Charges,62% of total BIlled charges,2072.7,63,,1658.16,percent of total Billed Charges,63% of total Billed Charges,2796.5,85,,2237.2,percent of total Billed Charges,85% of total Billed Charges,2632,80,,2105.6,percent of total Billed Charges,80% of total Billed Charges,2039.8,62,,1631.84,percent of total Billed Charges,62% of total Billed Charges,2072.7,63,,1658.16,percent of total Billed Charges,63% of total Billed Charges,2039.8,62,,1631.84,percent of total Billed Charges,62% of total Billed Charges,2072.7,63,,1658.16,percent of total billed charges,63% of total Billed Charges,2039.8,62,,1631.84,percent of total Billed Charges,62% of total Billed Charges,2632,80,,2105.6,percent of total Billed Charges,80% of Total Billed Charges,2039.8,62,,1631.84,percent of total Billed Charges,62% of total Billed Charges,2039.8,62,,1631.84,percent of total Billed Charges,62% of total Billed Charges,2039.8,2796.5,
47562 - Cholecystectomy Laparoscopy,547562,CDM,360,RC,47562,HCPCS,Outpatient,,,7443,5210.1,,5954.4,80,,4763.52,percent of total Billed Charges,80% of Total Billed Charges,4689.09,63,,3751.272,percent of total Billed charges,63% of Total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total BIlled charges,4689.09,63,,3751.272,percent of total Billed Charges,63% of total Billed Charges,6326.55,85,,5061.24,percent of total Billed Charges,85% of total Billed Charges,5954.4,80,,4763.52,percent of total Billed Charges,80% of total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total Billed Charges,4689.09,63,,3751.272,percent of total Billed Charges,63% of total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total Billed Charges,4689.09,63,,3751.272,percent of total billed charges,63% of total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total Billed Charges,5954.4,80,,4763.52,percent of total Billed Charges,80% of Total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total Billed Charges,4614.66,6326.55,
47610 - Cholecystectomy with Cholangiogram and Common Duct Exploration,547610,CDM,360,RC,47610,HCPCS,Outpatient,,,3978,2784.6,,3182.4,80,,2545.92,percent of total Billed Charges,80% of Total Billed Charges,2506.14,63,,2004.912,percent of total Billed charges,63% of Total Billed Charges,2466.36,62,,1973.088,percent of total Billed Charges,62% of total BIlled charges,2506.14,63,,2004.912,percent of total Billed Charges,63% of total Billed Charges,3381.3,85,,2705.04,percent of total Billed Charges,85% of total Billed Charges,3182.4,80,,2545.92,percent of total Billed Charges,80% of total Billed Charges,2466.36,62,,1973.088,percent of total Billed Charges,62% of total Billed Charges,2506.14,63,,2004.912,percent of total Billed Charges,63% of total Billed Charges,2466.36,62,,1973.088,percent of total Billed Charges,62% of total Billed Charges,2506.14,63,,2004.912,percent of total billed charges,63% of total Billed Charges,2466.36,62,,1973.088,percent of total Billed Charges,62% of total Billed Charges,3182.4,80,,2545.92,percent of total Billed Charges,80% of Total Billed Charges,2466.36,62,,1973.088,percent of total Billed Charges,62% of total Billed Charges,2466.36,62,,1973.088,percent of total Billed Charges,62% of total Billed Charges,2466.36,3381.3,
54161 - Circumcision,554161,CDM,360,RC,54161,HCPCS,Outpatient,,,638,446.6,,510.4,80,,408.32,percent of total Billed Charges,80% of Total Billed Charges,401.94,63,,321.552,percent of total Billed charges,63% of Total Billed Charges,395.56,62,,316.448,percent of total Billed Charges,62% of total BIlled charges,401.94,63,,321.552,percent of total Billed Charges,63% of total Billed Charges,542.3,85,,433.84,percent of total Billed Charges,85% of total Billed Charges,510.4,80,,408.32,percent of total Billed Charges,80% of total Billed Charges,395.56,62,,316.448,percent of total Billed Charges,62% of total Billed Charges,401.94,63,,321.552,percent of total Billed Charges,63% of total Billed Charges,395.56,62,,316.448,percent of total Billed Charges,62% of total Billed Charges,401.94,63,,321.552,percent of total billed charges,63% of total Billed Charges,395.56,62,,316.448,percent of total Billed Charges,62% of total Billed Charges,510.4,80,,408.32,percent of total Billed Charges,80% of Total Billed Charges,395.56,62,,316.448,percent of total Billed Charges,62% of total Billed Charges,395.56,62,,316.448,percent of total Billed Charges,62% of total Billed Charges,395.56,542.3,
27080 - Coccygectomy,527080,CDM,360,RC,27080,HCPCS,Outpatient,,,5255,3678.5,,4204,80,,3363.2,percent of total Billed Charges,80% of Total Billed Charges,3310.65,63,,2648.52,percent of total Billed charges,63% of Total Billed Charges,3258.1,62,,2606.48,percent of total Billed Charges,62% of total BIlled charges,3310.65,63,,2648.52,percent of total Billed Charges,63% of total Billed Charges,4466.75,85,,3573.4,percent of total Billed Charges,85% of total Billed Charges,4204,80,,3363.2,percent of total Billed Charges,80% of total Billed Charges,3258.1,62,,2606.48,percent of total Billed Charges,62% of total Billed Charges,3310.65,63,,2648.52,percent of total Billed Charges,63% of total Billed Charges,3258.1,62,,2606.48,percent of total Billed Charges,62% of total Billed Charges,3310.65,63,,2648.52,percent of total billed charges,63% of total Billed Charges,3258.1,62,,2606.48,percent of total Billed Charges,62% of total Billed Charges,4204,80,,3363.2,percent of total Billed Charges,80% of Total Billed Charges,3258.1,62,,2606.48,percent of total Billed Charges,62% of total Billed Charges,3258.1,62,,2606.48,percent of total Billed Charges,62% of total Billed Charges,3258.1,4466.75,
45380 - Colonoscopy Biopsy,50250,CDM,360,RC,45380,HCPCS,Outpatient,,,1503,1052.1,,1202.4,80,,961.92,percent of total Billed Charges,80% of Total Billed Charges,946.89,63,,757.512,percent of total Billed charges,63% of Total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total BIlled charges,946.89,63,,757.512,percent of total Billed Charges,63% of total Billed Charges,1277.55,85,,1022.04,percent of total Billed Charges,85% of total Billed Charges,1202.4,80,,961.92,percent of total Billed Charges,80% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,946.89,63,,757.512,percent of total Billed Charges,63% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,946.89,63,,757.512,percent of total billed charges,63% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,1202.4,80,,961.92,percent of total Billed Charges,80% of Total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,931.86,1277.55,
45379 - Colonoscopy Foreign Body Removal,50249,CDM,360,RC,45379,HCPCS,Outpatient,,,1503,1052.1,,1202.4,80,,961.92,percent of total Billed Charges,80% of Total Billed Charges,946.89,63,,757.512,percent of total Billed charges,63% of Total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total BIlled charges,946.89,63,,757.512,percent of total Billed Charges,63% of total Billed Charges,1277.55,85,,1022.04,percent of total Billed Charges,85% of total Billed Charges,1202.4,80,,961.92,percent of total Billed Charges,80% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,946.89,63,,757.512,percent of total Billed Charges,63% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,946.89,63,,757.512,percent of total billed charges,63% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,1202.4,80,,961.92,percent of total Billed Charges,80% of Total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,931.86,1277.55,
52005 - Cystoscopy Catheterization Ureter,552005,CDM,360,RC,52005,HCPCS,Outpatient,,,4095,2866.5,,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2579.85,63,,2063.88,percent of total Billed charges,63% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total BIlled charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,3480.75,85,,2784.6,percent of total Billed Charges,85% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total billed charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,3480.75,
52001 - Cystoscopy Evacuation Clots,552001,CDM,360,RC,52001,HCPCS,Outpatient,,,2458,1720.6,,1966.4,80,,1573.12,percent of total Billed Charges,80% of Total Billed Charges,1548.54,63,,1238.832,percent of total Billed charges,63% of Total Billed Charges,1523.96,62,,1219.168,percent of total Billed Charges,62% of total BIlled charges,1548.54,63,,1238.832,percent of total Billed Charges,63% of total Billed Charges,2089.3,85,,1671.44,percent of total Billed Charges,85% of total Billed Charges,1966.4,80,,1573.12,percent of total Billed Charges,80% of total Billed Charges,1523.96,62,,1219.168,percent of total Billed Charges,62% of total Billed Charges,1548.54,63,,1238.832,percent of total Billed Charges,63% of total Billed Charges,1523.96,62,,1219.168,percent of total Billed Charges,62% of total Billed Charges,1548.54,63,,1238.832,percent of total billed charges,63% of total Billed Charges,1523.96,62,,1219.168,percent of total Billed Charges,62% of total Billed Charges,1966.4,80,,1573.12,percent of total Billed Charges,80% of Total Billed Charges,1523.96,62,,1219.168,percent of total Billed Charges,62% of total Billed Charges,1523.96,62,,1219.168,percent of total Billed Charges,62% of total Billed Charges,1523.96,2089.3,
52332 - Cystoscopy Insertion Stent Ureter,552332,CDM,360,RC,52332,HCPCS,Outpatient,,,4095,2866.5,,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2579.85,63,,2063.88,percent of total Billed charges,63% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total BIlled charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,3480.75,85,,2784.6,percent of total Billed Charges,85% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total billed charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,3480.75,
52310 - Cystoscopy Removal Stent Ureter,552310,CDM,360,RC,52310,HCPCS,Outpatient,,,3480,2436,,2784,80,,2227.2,percent of total Billed Charges,80% of Total Billed Charges,2192.4,63,,1753.92,percent of total Billed charges,63% of Total Billed Charges,2157.6,62,,1726.08,percent of total Billed Charges,62% of total BIlled charges,2192.4,63,,1753.92,percent of total Billed Charges,63% of total Billed Charges,2958,85,,2366.4,percent of total Billed Charges,85% of total Billed Charges,2784,80,,2227.2,percent of total Billed Charges,80% of total Billed Charges,2157.6,62,,1726.08,percent of total Billed Charges,62% of total Billed Charges,2192.4,63,,1753.92,percent of total Billed Charges,63% of total Billed Charges,2157.6,62,,1726.08,percent of total Billed Charges,62% of total Billed Charges,2192.4,63,,1753.92,percent of total billed charges,63% of total Billed Charges,2157.6,62,,1726.08,percent of total Billed Charges,62% of total Billed Charges,2784,80,,2227.2,percent of total Billed Charges,80% of Total Billed Charges,2157.6,62,,1726.08,percent of total Billed Charges,62% of total Billed Charges,2157.6,62,,1726.08,percent of total Billed Charges,62% of total Billed Charges,2157.6,2958,
51050 - Cystostomy,551050,CDM,360,RC,51050,HCPCS,Outpatient,,,4095,2866.5,,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2579.85,63,,2063.88,percent of total Billed charges,63% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total BIlled charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,3480.75,85,,2784.6,percent of total Billed Charges,85% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total billed charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,3480.75,
11042 - Debridement Abdomen,511042,CDM,360,RC,11042,HCPCS,Outpatient,,,561,392.7,,448.8,80,,359.04,percent of total Billed Charges,80% of Total Billed Charges,353.43,63,,282.744,percent of total Billed charges,63% of Total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total BIlled charges,353.43,63,,282.744,percent of total Billed Charges,63% of total Billed Charges,476.85,85,,381.48,percent of total Billed Charges,85% of total Billed Charges,448.8,80,,359.04,percent of total Billed Charges,80% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,353.43,63,,282.744,percent of total Billed Charges,63% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,353.43,63,,282.744,percent of total billed charges,63% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,448.8,80,,359.04,percent of total Billed Charges,80% of Total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,347.82,476.85,
11005 - Debridement Abdominal Wall,511005,CDM,360,RC,11005,HCPCS,Outpatient,,,2423,1696.1,,1938.4,80,,1550.72,percent of total Billed Charges,80% of Total Billed Charges,1526.49,63,,1221.192,percent of total Billed charges,63% of Total Billed Charges,1502.26,62,,1201.808,percent of total Billed Charges,62% of total BIlled charges,1526.49,63,,1221.192,percent of total Billed Charges,63% of total Billed Charges,2059.55,85,,1647.64,percent of total Billed Charges,85% of total Billed Charges,1938.4,80,,1550.72,percent of total Billed Charges,80% of total Billed Charges,1502.26,62,,1201.808,percent of total Billed Charges,62% of total Billed Charges,1526.49,63,,1221.192,percent of total Billed Charges,63% of total Billed Charges,1502.26,62,,1201.808,percent of total Billed Charges,62% of total Billed Charges,1526.49,63,,1221.192,percent of total billed charges,63% of total Billed Charges,1502.26,62,,1201.808,percent of total Billed Charges,62% of total Billed Charges,1938.4,80,,1550.72,percent of total Billed Charges,80% of Total Billed Charges,1502.26,62,,1201.808,percent of total Billed Charges,62% of total Billed Charges,1502.26,62,,1201.808,percent of total Billed Charges,62% of total Billed Charges,1502.26,2059.55,
11043 - Debridement Back,511043,CDM,360,RC,11043,HCPCS,Outpatient,,,561,392.7,,448.8,80,,359.04,percent of total Billed Charges,80% of Total Billed Charges,353.43,63,,282.744,percent of total Billed charges,63% of Total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total BIlled charges,353.43,63,,282.744,percent of total Billed Charges,63% of total Billed Charges,476.85,85,,381.48,percent of total Billed Charges,85% of total Billed Charges,448.8,80,,359.04,percent of total Billed Charges,80% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,353.43,63,,282.744,percent of total Billed Charges,63% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,353.43,63,,282.744,percent of total billed charges,63% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,448.8,80,,359.04,percent of total Billed Charges,80% of Total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,347.82,476.85,
11044 - Debridement Chest,511044,CDM,360,RC,11044,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
11046 - Debridement Flank,511046,CDM,360,RC,11046,HCPCS,Outpatient,,,168,117.6,,134.4,80,,107.52,percent of total Billed Charges,80% of Total Billed Charges,105.84,63,,84.672,percent of total Billed charges,63% of Total Billed Charges,104.16,62,,83.328,percent of total Billed Charges,62% of total BIlled charges,105.84,63,,84.672,percent of total Billed Charges,63% of total Billed Charges,142.8,85,,114.24,percent of total Billed Charges,85% of total Billed Charges,134.4,80,,107.52,percent of total Billed Charges,80% of total Billed Charges,104.16,62,,83.328,percent of total Billed Charges,62% of total Billed Charges,105.84,63,,84.672,percent of total Billed Charges,63% of total Billed Charges,104.16,62,,83.328,percent of total Billed Charges,62% of total Billed Charges,105.84,63,,84.672,percent of total billed charges,63% of total Billed Charges,104.16,62,,83.328,percent of total Billed Charges,62% of total Billed Charges,134.4,80,,107.52,percent of total Billed Charges,80% of Total Billed Charges,104.16,62,,83.328,percent of total Billed Charges,62% of total Billed Charges,104.16,62,,83.328,percent of total Billed Charges,62% of total Billed Charges,104.16,142.8,
11045 - Debridement Hand,511045,CDM,360,RC,11045,HCPCS,Outpatient,,,87,60.9,,69.6,80,,55.68,percent of total Billed Charges,80% of Total Billed Charges,54.81,63,,43.848,percent of total Billed charges,63% of Total Billed Charges,53.94,62,,43.152,percent of total Billed Charges,62% of total BIlled charges,54.81,63,,43.848,percent of total Billed Charges,63% of total Billed Charges,73.95,85,,59.16,percent of total Billed Charges,85% of total Billed Charges,69.6,80,,55.68,percent of total Billed Charges,80% of total Billed Charges,53.94,62,,43.152,percent of total Billed Charges,62% of total Billed Charges,54.81,63,,43.848,percent of total Billed Charges,63% of total Billed Charges,53.94,62,,43.152,percent of total Billed Charges,62% of total Billed Charges,54.81,63,,43.848,percent of total billed charges,63% of total Billed Charges,53.94,62,,43.152,percent of total Billed Charges,62% of total Billed Charges,69.6,80,,55.68,percent of total Billed Charges,80% of Total Billed Charges,53.94,62,,43.152,percent of total Billed Charges,62% of total Billed Charges,53.94,62,,43.152,percent of total Billed Charges,62% of total Billed Charges,53.94,73.95,
11000 - Debridement Perineum,511000,CDM,360,RC,11000,HCPCS,Outpatient,,,128,89.6,,102.4,80,,81.92,percent of total Billed Charges,80% of Total Billed Charges,80.64,63,,64.512,percent of total Billed charges,63% of Total Billed Charges,79.36,62,,63.488,percent of total Billed Charges,62% of total BIlled charges,80.64,63,,64.512,percent of total Billed Charges,63% of total Billed Charges,108.8,85,,87.04,percent of total Billed Charges,85% of total Billed Charges,102.4,80,,81.92,percent of total Billed Charges,80% of total Billed Charges,79.36,62,,63.488,percent of total Billed Charges,62% of total Billed Charges,80.64,63,,64.512,percent of total Billed Charges,63% of total Billed Charges,79.36,62,,63.488,percent of total Billed Charges,62% of total Billed Charges,80.64,63,,64.512,percent of total billed charges,63% of total Billed Charges,79.36,62,,63.488,percent of total Billed Charges,62% of total Billed Charges,102.4,80,,81.92,percent of total Billed Charges,80% of Total Billed Charges,79.36,62,,63.488,percent of total Billed Charges,62% of total Billed Charges,79.36,62,,63.488,percent of total Billed Charges,62% of total Billed Charges,79.36,108.8,
11010 - Debridement Upper Extremity,511010,CDM,360,RC,11010,HCPCS,Outpatient,,,1938,1356.6,,1550.4,80,,1240.32,percent of total Billed Charges,80% of Total Billed Charges,1220.94,63,,976.752,percent of total Billed charges,63% of Total Billed Charges,1201.56,62,,961.248,percent of total Billed Charges,62% of total BIlled charges,1220.94,63,,976.752,percent of total Billed Charges,63% of total Billed Charges,1647.3,85,,1317.84,percent of total Billed Charges,85% of total Billed Charges,1550.4,80,,1240.32,percent of total Billed Charges,80% of total Billed Charges,1201.56,62,,961.248,percent of total Billed Charges,62% of total Billed Charges,1220.94,63,,976.752,percent of total Billed Charges,63% of total Billed Charges,1201.56,62,,961.248,percent of total Billed Charges,62% of total Billed Charges,1220.94,63,,976.752,percent of total billed charges,63% of total Billed Charges,1201.56,62,,961.248,percent of total Billed Charges,62% of total Billed Charges,1550.4,80,,1240.32,percent of total Billed Charges,80% of Total Billed Charges,1201.56,62,,961.248,percent of total Billed Charges,62% of total Billed Charges,1201.56,62,,961.248,percent of total Billed Charges,62% of total Billed Charges,1201.56,1647.3,
64721 - Decompression Endoscopy Nerve Median with Carpal Tunnel Release,564721,CDM,360,RC,64721,HCPCS,Outpatient,,,2823,1976.1,,2258.4,80,,1806.72,percent of total Billed Charges,80% of Total Billed Charges,1778.49,63,,1422.792,percent of total Billed charges,63% of Total Billed Charges,1750.26,62,,1400.208,percent of total Billed Charges,62% of total BIlled charges,1778.49,63,,1422.792,percent of total Billed Charges,63% of total Billed Charges,2399.55,85,,1919.64,percent of total Billed Charges,85% of total Billed Charges,2258.4,80,,1806.72,percent of total Billed Charges,80% of total Billed Charges,1750.26,62,,1400.208,percent of total Billed Charges,62% of total Billed Charges,1778.49,63,,1422.792,percent of total Billed Charges,63% of total Billed Charges,1750.26,62,,1400.208,percent of total Billed Charges,62% of total Billed Charges,1778.49,63,,1422.792,percent of total billed charges,63% of total Billed Charges,1750.26,62,,1400.208,percent of total Billed Charges,62% of total Billed Charges,2258.4,80,,1806.72,percent of total Billed Charges,80% of Total Billed Charges,1750.26,62,,1400.208,percent of total Billed Charges,62% of total Billed Charges,1750.26,62,,1400.208,percent of total Billed Charges,62% of total Billed Charges,1750.26,2399.55,
43235 - Esophagogastroduodenoscopy,50240,CDM,360,RC,43235,HCPCS,Outpatient,,,1368,957.6,,1094.4,80,,875.52,percent of total Billed Charges,80% of Total Billed Charges,861.84,63,,689.472,percent of total Billed charges,63% of Total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total BIlled charges,861.84,63,,689.472,percent of total Billed Charges,63% of total Billed Charges,1162.8,85,,930.24,percent of total Billed Charges,85% of total Billed Charges,1094.4,80,,875.52,percent of total Billed Charges,80% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,861.84,63,,689.472,percent of total Billed Charges,63% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,861.84,63,,689.472,percent of total billed charges,63% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,1094.4,80,,875.52,percent of total Billed Charges,80% of Total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,848.16,1162.8,
43239 - Esophagogastroduodenoscopy Biopsy,50241,CDM,360,RC,43239,HCPCS,Outpatient,,,1368,957.6,,1094.4,80,,875.52,percent of total Billed Charges,80% of Total Billed Charges,861.84,63,,689.472,percent of total Billed charges,63% of Total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total BIlled charges,861.84,63,,689.472,percent of total Billed Charges,63% of total Billed Charges,1162.8,85,,930.24,percent of total Billed Charges,85% of total Billed Charges,1094.4,80,,875.52,percent of total Billed Charges,80% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,861.84,63,,689.472,percent of total Billed Charges,63% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,861.84,63,,689.472,percent of total billed charges,63% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,1094.4,80,,875.52,percent of total Billed Charges,80% of Total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,848.16,1162.8,
43255 - Esophagogastroduodenoscopy Control Bleeding,50260,CDM,360,RC,43255,HCPCS,Outpatient,,,2173,1521.1,,1738.4,80,,1390.72,percent of total Billed Charges,80% of Total Billed Charges,1368.99,63,,1095.192,percent of total Billed charges,63% of Total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total BIlled charges,1368.99,63,,1095.192,percent of total Billed Charges,63% of total Billed Charges,1847.05,85,,1477.64,percent of total Billed Charges,85% of total Billed Charges,1738.4,80,,1390.72,percent of total Billed Charges,80% of total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total Billed Charges,1368.99,63,,1095.192,percent of total Billed Charges,63% of total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total Billed Charges,1368.99,63,,1095.192,percent of total billed charges,63% of total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total Billed Charges,1738.4,80,,1390.72,percent of total Billed Charges,80% of Total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total Billed Charges,1347.26,1847.05,
43251 - Esophagogastroduodenoscopy Excision Lesion,50261,CDM,360,RC,43251,HCPCS,Outpatient,,,2173,1521.1,,1738.4,80,,1390.72,percent of total Billed Charges,80% of Total Billed Charges,1368.99,63,,1095.192,percent of total Billed charges,63% of Total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total BIlled charges,1368.99,63,,1095.192,percent of total Billed Charges,63% of total Billed Charges,1847.05,85,,1477.64,percent of total Billed Charges,85% of total Billed Charges,1738.4,80,,1390.72,percent of total Billed Charges,80% of total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total Billed Charges,1368.99,63,,1095.192,percent of total Billed Charges,63% of total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total Billed Charges,1368.99,63,,1095.192,percent of total billed charges,63% of total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total Billed Charges,1738.4,80,,1390.72,percent of total Billed Charges,80% of Total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total Billed Charges,1347.26,1847.05,
43247 - Esophagogastroduodenoscopy Foreign Body Removal,543247,CDM,360,RC,43247,HCPCS,Outpatient,,,1368,957.6,,1094.4,80,,875.52,percent of total Billed Charges,80% of Total Billed Charges,861.84,63,,689.472,percent of total Billed charges,63% of Total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total BIlled charges,861.84,63,,689.472,percent of total Billed Charges,63% of total Billed Charges,1162.8,85,,930.24,percent of total Billed Charges,85% of total Billed Charges,1094.4,80,,875.52,percent of total Billed Charges,80% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,861.84,63,,689.472,percent of total Billed Charges,63% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,861.84,63,,689.472,percent of total billed charges,63% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,1094.4,80,,875.52,percent of total Billed Charges,80% of Total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,848.16,1162.8,
43248 - Esophagogastroduodenoscopy Guided Dilatation,50257,CDM,360,RC,43248,HCPCS,Outpatient,,,1368,957.6,,1094.4,80,,875.52,percent of total Billed Charges,80% of Total Billed Charges,861.84,63,,689.472,percent of total Billed charges,63% of Total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total BIlled charges,861.84,63,,689.472,percent of total Billed Charges,63% of total Billed Charges,1162.8,85,,930.24,percent of total Billed Charges,85% of total Billed Charges,1094.4,80,,875.52,percent of total Billed Charges,80% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,861.84,63,,689.472,percent of total Billed Charges,63% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,861.84,63,,689.472,percent of total billed charges,63% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,1094.4,80,,875.52,percent of total Billed Charges,80% of Total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,848.16,1162.8,
43236 - Esophagogastroduodenoscopy Injection Therapeutic Agent,543236,CDM,360,RC,43236,HCPCS,Outpatient,,,536,375.2,,428.8,80,,343.04,percent of total Billed Charges,80% of Total Billed Charges,337.68,63,,270.144,percent of total Billed charges,63% of Total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total BIlled charges,337.68,63,,270.144,percent of total Billed Charges,63% of total Billed Charges,455.6,85,,364.48,percent of total Billed Charges,85% of total Billed Charges,428.8,80,,343.04,percent of total Billed Charges,80% of total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total Billed Charges,337.68,63,,270.144,percent of total Billed Charges,63% of total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total Billed Charges,337.68,63,,270.144,percent of total billed charges,63% of total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total Billed Charges,428.8,80,,343.04,percent of total Billed Charges,80% of Total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total Billed Charges,332.32,455.6,
43246 - Esophagogastroduodenoscopy with Peg Placement,50242,CDM,360,RC,43246,HCPCS,Outpatient,,,2068,1447.6,,1654.4,80,,1323.52,percent of total Billed Charges,80% of Total Billed Charges,1302.84,63,,1042.272,percent of total Billed charges,63% of Total Billed Charges,1282.16,62,,1025.728,percent of total Billed Charges,62% of total BIlled charges,1302.84,63,,1042.272,percent of total Billed Charges,63% of total Billed Charges,1757.8,85,,1406.24,percent of total Billed Charges,85% of total Billed Charges,1654.4,80,,1323.52,percent of total Billed Charges,80% of total Billed Charges,1282.16,62,,1025.728,percent of total Billed Charges,62% of total Billed Charges,1302.84,63,,1042.272,percent of total Billed Charges,63% of total Billed Charges,1282.16,62,,1025.728,percent of total Billed Charges,62% of total Billed Charges,1302.84,63,,1042.272,percent of total billed charges,63% of total Billed Charges,1282.16,62,,1025.728,percent of total Billed Charges,62% of total Billed Charges,1654.4,80,,1323.52,percent of total Billed Charges,80% of Total Billed Charges,1282.16,62,,1025.728,percent of total Billed Charges,62% of total Billed Charges,1282.16,62,,1025.728,percent of total Billed Charges,62% of total Billed Charges,1282.16,1757.8,
10140 - Evacuation Hematoma Abdominal Cavity,510140,CDM,360,RC,10140,HCPCS,Outpatient,,,1724,1206.8,,1379.2,80,,1103.36,percent of total Billed Charges,80% of Total Billed Charges,1086.12,63,,868.896,percent of total Billed charges,63% of Total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total BIlled charges,1086.12,63,,868.896,percent of total Billed Charges,63% of total Billed Charges,1465.4,85,,1172.32,percent of total Billed Charges,85% of total Billed Charges,1379.2,80,,1103.36,percent of total Billed Charges,80% of total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1086.12,63,,868.896,percent of total Billed Charges,63% of total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1086.12,63,,868.896,percent of total billed charges,63% of total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1379.2,80,,1103.36,percent of total Billed Charges,80% of Total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1068.88,1465.4,
45990 - Examination Under Anesthesia Rectum,536560,CDM,360,RC,45990,HCPCS,Outpatient,,,7033,4923.1,,5626.4,80,,4501.12,percent of total Billed Charges,80% of Total Billed Charges,4430.79,63,,3544.632,percent of total Billed charges,63% of Total Billed Charges,4360.46,62,,3488.368,percent of total Billed Charges,62% of total BIlled charges,4430.79,63,,3544.632,percent of total Billed Charges,63% of total Billed Charges,5978.05,85,,4782.44,percent of total Billed Charges,85% of total Billed Charges,5626.4,80,,4501.12,percent of total Billed Charges,80% of total Billed Charges,4360.46,62,,3488.368,percent of total Billed Charges,62% of total Billed Charges,4430.79,63,,3544.632,percent of total Billed Charges,63% of total Billed Charges,4360.46,62,,3488.368,percent of total Billed Charges,62% of total Billed Charges,4430.79,63,,3544.632,percent of total billed charges,63% of total Billed Charges,4360.46,62,,3488.368,percent of total Billed Charges,62% of total Billed Charges,5626.4,80,,4501.12,percent of total Billed Charges,80% of Total Billed Charges,4360.46,62,,3488.368,percent of total Billed Charges,62% of total Billed Charges,4360.46,62,,3488.368,percent of total Billed Charges,62% of total Billed Charges,4360.46,5978.05,
28108 - Excision Bone Cyst Foot,528108,CDM,360,RC,28108,HCPCS,Outpatient,,,3435,2404.5,,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2164.05,63,,1731.24,percent of total Billed charges,63% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total BIlled charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2919.75,85,,2335.8,percent of total Billed Charges,85% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total billed charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,2919.75,
28122 - Excision Bone Foot with Bone Graft,528122,CDM,360,RC,28122,HCPCS,Outpatient,,,3570,2499,,2856,80,,2284.8,percent of total Billed Charges,80% of Total Billed Charges,2249.1,63,,1799.28,percent of total Billed charges,63% of Total Billed Charges,2213.4,62,,1770.72,percent of total Billed Charges,62% of total BIlled charges,2249.1,63,,1799.28,percent of total Billed Charges,63% of total Billed Charges,3034.5,85,,2427.6,percent of total Billed Charges,85% of total Billed Charges,2856,80,,2284.8,percent of total Billed Charges,80% of total Billed Charges,2213.4,62,,1770.72,percent of total Billed Charges,62% of total Billed Charges,2249.1,63,,1799.28,percent of total Billed Charges,63% of total Billed Charges,2213.4,62,,1770.72,percent of total Billed Charges,62% of total Billed Charges,2249.1,63,,1799.28,percent of total billed charges,63% of total Billed Charges,2213.4,62,,1770.72,percent of total Billed Charges,62% of total Billed Charges,2856,80,,2284.8,percent of total Billed Charges,80% of Total Billed Charges,2213.4,62,,1770.72,percent of total Billed Charges,62% of total Billed Charges,2213.4,62,,1770.72,percent of total Billed Charges,62% of total Billed Charges,2213.4,3034.5,
27345 - Excision Cyst Bakers,527345,CDM,360,RC,27345,HCPCS,Outpatient,,,3345,2341.5,,2676,80,,2140.8,percent of total Billed Charges,80% of Total Billed Charges,2107.35,63,,1685.88,percent of total Billed charges,63% of Total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total BIlled charges,2107.35,63,,1685.88,percent of total Billed Charges,63% of total Billed Charges,2843.25,85,,2274.6,percent of total Billed Charges,85% of total Billed Charges,2676,80,,2140.8,percent of total Billed Charges,80% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2107.35,63,,1685.88,percent of total Billed Charges,63% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2107.35,63,,1685.88,percent of total billed charges,63% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2676,80,,2140.8,percent of total Billed Charges,80% of Total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2073.9,2843.25,
56740 - Excision Cyst Female Genitalia,556740,CDM,360,RC,56740,HCPCS,Outpatient,,,5147,3602.9,,4117.6,80,,3294.08,percent of total Billed Charges,80% of Total Billed Charges,3242.61,63,,2594.088,percent of total Billed charges,63% of Total Billed Charges,3191.14,62,,2552.912,percent of total Billed Charges,62% of total BIlled charges,3242.61,63,,2594.088,percent of total Billed Charges,63% of total Billed Charges,4374.95,85,,3499.96,percent of total Billed Charges,85% of total Billed Charges,4117.6,80,,3294.08,percent of total Billed Charges,80% of total Billed Charges,3191.14,62,,2552.912,percent of total Billed Charges,62% of total Billed Charges,3242.61,63,,2594.088,percent of total Billed Charges,63% of total Billed Charges,3191.14,62,,2552.912,percent of total Billed Charges,62% of total Billed Charges,3242.61,63,,2594.088,percent of total billed charges,63% of total Billed Charges,3191.14,62,,2552.912,percent of total Billed Charges,62% of total Billed Charges,4117.6,80,,3294.08,percent of total Billed Charges,80% of Total Billed Charges,3191.14,62,,2552.912,percent of total Billed Charges,62% of total Billed Charges,3191.14,62,,2552.912,percent of total Billed Charges,62% of total Billed Charges,3191.14,4374.95,
11770 - Excision Cyst Pilonidal,511770,CDM,360,RC,11770,HCPCS,Outpatient,,,3543,2480.1,,2834.4,80,,2267.52,percent of total Billed Charges,80% of Total Billed Charges,2232.09,63,,1785.672,percent of total Billed charges,63% of Total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total BIlled charges,2232.09,63,,1785.672,percent of total Billed Charges,63% of total Billed Charges,3011.55,85,,2409.24,percent of total Billed Charges,85% of total Billed Charges,2834.4,80,,2267.52,percent of total Billed Charges,80% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2232.09,63,,1785.672,percent of total Billed Charges,63% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2232.09,63,,1785.672,percent of total billed charges,63% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2834.4,80,,2267.52,percent of total Billed Charges,80% of Total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2196.66,3011.55,
27630 - Excision Ganglion Lower Extremity,527630,CDM,360,RC,27630,HCPCS,Outpatient,,,3345,2341.5,,2676,80,,2140.8,percent of total Billed Charges,80% of Total Billed Charges,2107.35,63,,1685.88,percent of total Billed charges,63% of Total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total BIlled charges,2107.35,63,,1685.88,percent of total Billed Charges,63% of total Billed Charges,2843.25,85,,2274.6,percent of total Billed Charges,85% of total Billed Charges,2676,80,,2140.8,percent of total Billed Charges,80% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2107.35,63,,1685.88,percent of total Billed Charges,63% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2107.35,63,,1685.88,percent of total billed charges,63% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2676,80,,2140.8,percent of total Billed Charges,80% of Total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2073.9,2843.25,
22900 - Excision Lesion Abdominal Cavity,522900,CDM,360,RC,22900,HCPCS,Outpatient,,,3543,2480.1,,2834.4,80,,2267.52,percent of total Billed Charges,80% of Total Billed Charges,2232.09,63,,1785.672,percent of total Billed charges,63% of Total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total BIlled charges,2232.09,63,,1785.672,percent of total Billed Charges,63% of total Billed Charges,3011.55,85,,2409.24,percent of total Billed Charges,85% of total Billed Charges,2834.4,80,,2267.52,percent of total Billed Charges,80% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2232.09,63,,1785.672,percent of total Billed Charges,63% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2232.09,63,,1785.672,percent of total billed charges,63% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2834.4,80,,2267.52,percent of total Billed Charges,80% of Total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2196.66,3011.55,
11444 - Excision Lesion Facial,511444,CDM,360,RC,11444,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
11620 - Excision Lesion Female Genitalia,511620,CDM,360,RC,11620,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
41114 - Excision Lesion Intraoral,541114,CDM,360,RC,41114,HCPCS,Outpatient,,,3793,2655.1,,3034.4,80,,2427.52,percent of total Billed Charges,80% of Total Billed Charges,2389.59,63,,1911.672,percent of total Billed charges,63% of Total Billed Charges,2351.66,62,,1881.328,percent of total Billed Charges,62% of total BIlled charges,2389.59,63,,1911.672,percent of total Billed Charges,63% of total Billed Charges,3224.05,85,,2579.24,percent of total Billed Charges,85% of total Billed Charges,3034.4,80,,2427.52,percent of total Billed Charges,80% of total Billed Charges,2351.66,62,,1881.328,percent of total Billed Charges,62% of total Billed Charges,2389.59,63,,1911.672,percent of total Billed Charges,63% of total Billed Charges,2351.66,62,,1881.328,percent of total Billed Charges,62% of total Billed Charges,2389.59,63,,1911.672,percent of total billed charges,63% of total Billed Charges,2351.66,62,,1881.328,percent of total Billed Charges,62% of total Billed Charges,3034.4,80,,2427.52,percent of total Billed Charges,80% of Total Billed Charges,2351.66,62,,1881.328,percent of total Billed Charges,62% of total Billed Charges,2351.66,62,,1881.328,percent of total Billed Charges,62% of total Billed Charges,2351.66,3224.05,
28092 - Excision Lesion Lower Extremity,528092,CDM,360,RC,28092,HCPCS,Outpatient,,,3435,2404.5,,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2164.05,63,,1731.24,percent of total Billed charges,63% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total BIlled charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2919.75,85,,2335.8,percent of total Billed Charges,85% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total billed charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,2919.75,
11622 - Excision Lesion Male Genitalia,511622,CDM,360,RC,11622,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
45171 - Excision Lesion Rectum,545171,CDM,360,RC,45171,HCPCS,Outpatient,,,4650,3255,,3720,80,,2976,percent of total Billed Charges,80% of Total Billed Charges,2929.5,63,,2343.6,percent of total Billed charges,63% of Total Billed Charges,2883,62,,2306.4,percent of total Billed Charges,62% of total BIlled charges,2929.5,63,,2343.6,percent of total Billed Charges,63% of total Billed Charges,3952.5,85,,3162,percent of total Billed Charges,85% of total Billed Charges,3720,80,,2976,percent of total Billed Charges,80% of total Billed Charges,2883,62,,2306.4,percent of total Billed Charges,62% of total Billed Charges,2929.5,63,,2343.6,percent of total Billed Charges,63% of total Billed Charges,2883,62,,2306.4,percent of total Billed Charges,62% of total Billed Charges,2929.5,63,,2343.6,percent of total billed charges,63% of total Billed Charges,2883,62,,2306.4,percent of total Billed Charges,62% of total Billed Charges,3720,80,,2976,percent of total Billed Charges,80% of Total Billed Charges,2883,62,,2306.4,percent of total Billed Charges,62% of total Billed Charges,2883,62,,2306.4,percent of total Billed Charges,62% of total Billed Charges,2883,3952.5,
11443 - Excision Lesion Skin Benign Head/Neck,511443,CDM,360,RC,11443,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
11400 - Excision Lesion Skin Benign Lower Extremity,511400,CDM,360,RC,11400,HCPCS,Outpatient,,,651,455.7,,520.8,80,,416.64,percent of total Billed Charges,80% of Total Billed Charges,410.13,63,,328.104,percent of total Billed charges,63% of Total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total BIlled charges,410.13,63,,328.104,percent of total Billed Charges,63% of total Billed Charges,553.35,85,,442.68,percent of total Billed Charges,85% of total Billed Charges,520.8,80,,416.64,percent of total Billed Charges,80% of total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total Billed Charges,410.13,63,,328.104,percent of total Billed Charges,63% of total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total Billed Charges,410.13,63,,328.104,percent of total billed charges,63% of total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total Billed Charges,520.8,80,,416.64,percent of total Billed Charges,80% of Total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total Billed Charges,403.62,553.35,
11424 - Excision Lesion Skin Benign Upper Extremity,511424,CDM,360,RC,11424,HCPCS,Outpatient,,,2339,1637.3,,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1473.57,63,,1178.856,percent of total Billed charges,63% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total BIlled charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1988.15,85,,1590.52,percent of total Billed Charges,85% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total billed charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,1988.15,
11600 - Excision Lesion Skin Malignant Lower Extremity,511600,CDM,360,RC,11600,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
11626 - Excision Lesion Skin Malignant Torso,511626,CDM,360,RC,11626,HCPCS,Outpatient,,,3543,2480.1,,2834.4,80,,2267.52,percent of total Billed Charges,80% of Total Billed Charges,2232.09,63,,1785.672,percent of total Billed charges,63% of Total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total BIlled charges,2232.09,63,,1785.672,percent of total Billed Charges,63% of total Billed Charges,3011.55,85,,2409.24,percent of total Billed Charges,85% of total Billed Charges,2834.4,80,,2267.52,percent of total Billed Charges,80% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2232.09,63,,1785.672,percent of total Billed Charges,63% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2232.09,63,,1785.672,percent of total billed charges,63% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2834.4,80,,2267.52,percent of total Billed Charges,80% of Total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2196.66,3011.55,
11621 - Excision Lesion Skin Malignant Upper Extremity,511621,CDM,360,RC,11621,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
11422 - Excision Lesion Upper Extremity,511422,CDM,360,RC,11422,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
11442 - Excision Lipoma,511442,CDM,360,RC,11442,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
19120 - Excision Lipoma Breast,519120,CDM,360,RC,19120,HCPCS,Outpatient,,,4028,2819.6,,3222.4,80,,2577.92,percent of total Billed Charges,80% of Total Billed Charges,2537.64,63,,2030.112,percent of total Billed charges,63% of Total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total BIlled charges,2537.64,63,,2030.112,percent of total Billed Charges,63% of total Billed Charges,3423.8,85,,2739.04,percent of total Billed Charges,85% of total Billed Charges,3222.4,80,,2577.92,percent of total Billed Charges,80% of total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total Billed Charges,2537.64,63,,2030.112,percent of total Billed Charges,63% of total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total Billed Charges,2537.64,63,,2030.112,percent of total billed charges,63% of total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total Billed Charges,3222.4,80,,2577.92,percent of total Billed Charges,80% of Total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total Billed Charges,2497.36,3423.8,
21555 - Excision Lipoma Neck,521555,CDM,360,RC,21555,HCPCS,Outpatient,,,2339,1637.3,,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1473.57,63,,1178.856,percent of total Billed charges,63% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total BIlled charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1988.15,85,,1590.52,percent of total Billed Charges,85% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total billed charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,1988.15,
27047 - Excision Lipoma Pelvis,527047,CDM,360,RC,27047,HCPCS,Outpatient,,,2339,1637.3,,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1473.57,63,,1178.856,percent of total Billed charges,63% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total BIlled charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1988.15,85,,1590.52,percent of total Billed Charges,85% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total billed charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,1988.15,
40812 - Excision Mucocele,540812,CDM,360,RC,40812,HCPCS,Outpatient,,,2485,1739.5,,1988,80,,1590.4,percent of total Billed Charges,80% of Total Billed Charges,1565.55,63,,1252.44,percent of total Billed charges,63% of Total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total BIlled charges,1565.55,63,,1252.44,percent of total Billed Charges,63% of total Billed Charges,2112.25,85,,1689.8,percent of total Billed Charges,85% of total Billed Charges,1988,80,,1590.4,percent of total Billed Charges,80% of total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total Billed Charges,1565.55,63,,1252.44,percent of total Billed Charges,63% of total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total Billed Charges,1565.55,63,,1252.44,percent of total billed charges,63% of total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total Billed Charges,1988,80,,1590.4,percent of total Billed Charges,80% of Total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total Billed Charges,1540.7,2112.25,
42440 - Excision Salivary Gland,542440,CDM,360,RC,42440,HCPCS,Outpatient,,,7273,5091.1,,5818.4,80,,4654.72,percent of total Billed Charges,80% of Total Billed Charges,4581.99,63,,3665.592,percent of total Billed charges,63% of Total Billed Charges,4509.26,62,,3607.408,percent of total Billed Charges,62% of total BIlled charges,4581.99,63,,3665.592,percent of total Billed Charges,63% of total Billed Charges,6182.05,85,,4945.64,percent of total Billed Charges,85% of total Billed Charges,5818.4,80,,4654.72,percent of total Billed Charges,80% of total Billed Charges,4509.26,62,,3607.408,percent of total Billed Charges,62% of total Billed Charges,4581.99,63,,3665.592,percent of total Billed Charges,63% of total Billed Charges,4509.26,62,,3607.408,percent of total Billed Charges,62% of total Billed Charges,4581.99,63,,3665.592,percent of total billed charges,63% of total Billed Charges,4509.26,62,,3607.408,percent of total Billed Charges,62% of total Billed Charges,5818.4,80,,4654.72,percent of total Billed Charges,80% of Total Billed Charges,4509.26,62,,3607.408,percent of total Billed Charges,62% of total Billed Charges,4509.26,62,,3607.408,percent of total Billed Charges,62% of total Billed Charges,4509.26,6182.05,
28090 - Excision Wart Foot,528090,CDM,360,RC,28090,HCPCS,Outpatient,,,3435,2404.5,,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2164.05,63,,1731.24,percent of total Billed charges,63% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total BIlled charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2919.75,85,,2335.8,percent of total Billed Charges,85% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total billed charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,2919.75,
66982 - Extraction Cataract with Intraocular Lens Insertion,566982,CDM,360,RC,66982,HCPCS,Outpatient,,,3850,2695,,3080,80,,2464,percent of total Billed Charges,80% of Total Billed Charges,2425.5,63,,1940.4,percent of total Billed charges,63% of Total Billed Charges,2387,62,,1909.6,percent of total Billed Charges,62% of total BIlled charges,2425.5,63,,1940.4,percent of total Billed Charges,63% of total Billed Charges,3272.5,85,,2618,percent of total Billed Charges,85% of total Billed Charges,3080,80,,2464,percent of total Billed Charges,80% of total Billed Charges,2387,62,,1909.6,percent of total Billed Charges,62% of total Billed Charges,2425.5,63,,1940.4,percent of total Billed Charges,63% of total Billed Charges,2387,62,,1909.6,percent of total Billed Charges,62% of total Billed Charges,2425.5,63,,1940.4,percent of total billed charges,63% of total Billed Charges,2387,62,,1909.6,percent of total Billed Charges,62% of total Billed Charges,3080,80,,2464,percent of total Billed Charges,80% of Total Billed Charges,2387,62,,1909.6,percent of total Billed Charges,62% of total Billed Charges,2387,62,,1909.6,percent of total Billed Charges,62% of total Billed Charges,2387,3272.5,
28060 - Fasciectomy Lower Extremity,528060,CDM,360,RC,28060,HCPCS,Outpatient,,,3435,2404.5,,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2164.05,63,,1731.24,percent of total Billed charges,63% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total BIlled charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2919.75,85,,2335.8,percent of total Billed Charges,85% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total billed charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,2919.75,
46200 - Fissurectomy Anus,546200,CDM,360,RC,46200,HCPCS,Outpatient,,,3895,2726.5,,3116,80,,2492.8,percent of total Billed Charges,80% of Total Billed Charges,2453.85,63,,1963.08,percent of total Billed charges,63% of Total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total BIlled charges,2453.85,63,,1963.08,percent of total Billed Charges,63% of total Billed Charges,3310.75,85,,2648.6,percent of total Billed Charges,85% of total Billed Charges,3116,80,,2492.8,percent of total Billed Charges,80% of total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,2453.85,63,,1963.08,percent of total Billed Charges,63% of total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,2453.85,63,,1963.08,percent of total billed charges,63% of total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,3116,80,,2492.8,percent of total Billed Charges,80% of Total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,2414.9,3310.75,
46270 - Fistulectomy Anus,546270,CDM,360,RC,46270,HCPCS,Outpatient,,,3895,2726.5,,3116,80,,2492.8,percent of total Billed Charges,80% of Total Billed Charges,2453.85,63,,1963.08,percent of total Billed charges,63% of Total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total BIlled charges,2453.85,63,,1963.08,percent of total Billed Charges,63% of total Billed Charges,3310.75,85,,2648.6,percent of total Billed Charges,85% of total Billed Charges,3116,80,,2492.8,percent of total Billed Charges,80% of total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,2453.85,63,,1963.08,percent of total Billed Charges,63% of total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,2453.85,63,,1963.08,percent of total billed charges,63% of total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,3116,80,,2492.8,percent of total Billed Charges,80% of Total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,2414.9,3310.75,
46221 - Hemorrhoid Banding,546221,CDM,360,RC,46221,HCPCS,Outpatient,,,965,675.5,,772,80,,617.6,percent of total Billed Charges,80% of Total Billed Charges,607.95,63,,486.36,percent of total Billed charges,63% of Total Billed Charges,598.3,62,,478.64,percent of total Billed Charges,62% of total BIlled charges,607.95,63,,486.36,percent of total Billed Charges,63% of total Billed Charges,820.25,85,,656.2,percent of total Billed Charges,85% of total Billed Charges,772,80,,617.6,percent of total Billed Charges,80% of total Billed Charges,598.3,62,,478.64,percent of total Billed Charges,62% of total Billed Charges,607.95,63,,486.36,percent of total Billed Charges,63% of total Billed Charges,598.3,62,,478.64,percent of total Billed Charges,62% of total Billed Charges,607.95,63,,486.36,percent of total billed charges,63% of total Billed Charges,598.3,62,,478.64,percent of total Billed Charges,62% of total Billed Charges,772,80,,617.6,percent of total Billed Charges,80% of Total Billed Charges,598.3,62,,478.64,percent of total Billed Charges,62% of total Billed Charges,598.3,62,,478.64,percent of total Billed Charges,62% of total Billed Charges,598.3,820.25,
56442 - Hymenotomy,556720,CDM,360,RC,56442,HCPCS,Outpatient,,,2806,1964.2,,2244.8,80,,1795.84,percent of total Billed Charges,80% of Total Billed Charges,1767.78,63,,1414.224,percent of total Billed charges,63% of Total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total BIlled charges,1767.78,63,,1414.224,percent of total Billed Charges,63% of total Billed Charges,2385.1,85,,1908.08,percent of total Billed Charges,85% of total Billed Charges,2244.8,80,,1795.84,percent of total Billed Charges,80% of total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,1767.78,63,,1414.224,percent of total Billed Charges,63% of total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,1767.78,63,,1414.224,percent of total billed charges,63% of total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,2244.8,80,,1795.84,percent of total Billed Charges,80% of Total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,1739.72,2385.1,
10060 - Incision and Drainage Abdomen,510060,CDM,360,RC,10060,HCPCS,Outpatient,,,326,228.2,,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,205.38,63,,164.304,percent of total Billed charges,63% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total BIlled charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,277.1,85,,221.68,percent of total Billed Charges,85% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total billed charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,277.1,
69005 - Incision and Drainage Auricular,569005,CDM,360,RC,69005,HCPCS,Outpatient,,,1724,1206.8,,1379.2,80,,1103.36,percent of total Billed Charges,80% of Total Billed Charges,1086.12,63,,868.896,percent of total Billed charges,63% of Total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total BIlled charges,1086.12,63,,868.896,percent of total Billed Charges,63% of total Billed Charges,1465.4,85,,1172.32,percent of total Billed Charges,85% of total Billed Charges,1379.2,80,,1103.36,percent of total Billed Charges,80% of total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1086.12,63,,868.896,percent of total Billed Charges,63% of total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1086.12,63,,868.896,percent of total billed charges,63% of total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1379.2,80,,1103.36,percent of total Billed Charges,80% of Total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1068.88,1465.4,
10061 - Incision and Drainage Back,510061,CDM,360,RC,10061,HCPCS,Outpatient,,,326,228.2,,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,205.38,63,,164.304,percent of total Billed charges,63% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total BIlled charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,277.1,85,,221.68,percent of total Billed Charges,85% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total billed charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,277.1,
26990 - Incision and Drainage Hip,526990,CDM,360,RC,26990,HCPCS,Outpatient,,,3345,2341.5,,2676,80,,2140.8,percent of total Billed Charges,80% of Total Billed Charges,2107.35,63,,1685.88,percent of total Billed charges,63% of Total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total BIlled charges,2107.35,63,,1685.88,percent of total Billed Charges,63% of total Billed Charges,2843.25,85,,2274.6,percent of total Billed Charges,85% of total Billed Charges,2676,80,,2140.8,percent of total Billed Charges,80% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2107.35,63,,1685.88,percent of total Billed Charges,63% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2107.35,63,,1685.88,percent of total billed charges,63% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2676,80,,2140.8,percent of total Billed Charges,80% of Total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2073.9,2843.25,
27603 - Incision and Drainage Lower Extremity,527603,CDM,360,RC,27603,HCPCS,Outpatient,,,3202,2241.4,,2561.6,80,,2049.28,percent of total Billed Charges,80% of Total Billed Charges,2017.26,63,,1613.808,percent of total Billed charges,63% of Total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total BIlled charges,2017.26,63,,1613.808,percent of total Billed Charges,63% of total Billed Charges,2721.7,85,,2177.36,percent of total Billed Charges,85% of total Billed Charges,2561.6,80,,2049.28,percent of total Billed Charges,80% of total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,2017.26,63,,1613.808,percent of total Billed Charges,63% of total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,2017.26,63,,1613.808,percent of total billed charges,63% of total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,2561.6,80,,2049.28,percent of total Billed Charges,80% of Total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,1985.24,2721.7,
46040 - Incision and Drainage Rectal Abscess,546040,CDM,360,RC,46040,HCPCS,Outpatient,,,2897,2027.9,,2317.6,80,,1854.08,percent of total Billed Charges,80% of Total Billed Charges,1825.11,63,,1460.088,percent of total Billed charges,63% of Total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total BIlled charges,1825.11,63,,1460.088,percent of total Billed Charges,63% of total Billed Charges,2462.45,85,,1969.96,percent of total Billed Charges,85% of total Billed Charges,2317.6,80,,1854.08,percent of total Billed Charges,80% of total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total Billed Charges,1825.11,63,,1460.088,percent of total Billed Charges,63% of total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total Billed Charges,1825.11,63,,1460.088,percent of total billed charges,63% of total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total Billed Charges,2317.6,80,,1854.08,percent of total Billed Charges,80% of Total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total Billed Charges,1796.14,2462.45,
27301 - Incision and Drainage Thigh,527301,CDM,360,RC,27301,HCPCS,Outpatient,,,3202,2241.4,,2561.6,80,,2049.28,percent of total Billed Charges,80% of Total Billed Charges,2017.26,63,,1613.808,percent of total Billed charges,63% of Total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total BIlled charges,2017.26,63,,1613.808,percent of total Billed Charges,63% of total Billed Charges,2721.7,85,,2177.36,percent of total Billed Charges,85% of total Billed Charges,2561.6,80,,2049.28,percent of total Billed Charges,80% of total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,2017.26,63,,1613.808,percent of total Billed Charges,63% of total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,2017.26,63,,1613.808,percent of total billed charges,63% of total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,2561.6,80,,2049.28,percent of total Billed Charges,80% of Total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,1985.24,2721.7,
49320 - Laparoscopy Diagnostic,536558,CDM,360,RC,49320,HCPCS,Outpatient,,,9192,6434.4,,7353.6,80,,5882.88,percent of total Billed Charges,80% of Total Billed Charges,5790.96,63,,4632.768,percent of total Billed charges,63% of Total Billed Charges,5699.04,62,,4559.232,percent of total Billed Charges,62% of total BIlled charges,5790.96,63,,4632.768,percent of total Billed Charges,63% of total Billed Charges,7813.2,85,,6250.56,percent of total Billed Charges,85% of total Billed Charges,7353.6,80,,5882.88,percent of total Billed Charges,80% of total Billed Charges,5699.04,62,,4559.232,percent of total Billed Charges,62% of total Billed Charges,5790.96,63,,4632.768,percent of total Billed Charges,63% of total Billed Charges,5699.04,62,,4559.232,percent of total Billed Charges,62% of total Billed Charges,5790.96,63,,4632.768,percent of total billed charges,63% of total Billed Charges,5699.04,62,,4559.232,percent of total Billed Charges,62% of total Billed Charges,7353.6,80,,5882.88,percent of total Billed Charges,80% of Total Billed Charges,5699.04,62,,4559.232,percent of total Billed Charges,62% of total Billed Charges,5699.04,62,,4559.232,percent of total Billed Charges,62% of total Billed Charges,5699.04,7813.2,
15823 - Lift Eyebrow with Blepharoplasty,515823,CDM,360,RC,15823,HCPCS,Outpatient,,,2860,2002,,2288,80,,1830.4,percent of total Billed Charges,80% of Total Billed Charges,1801.8,63,,1441.44,percent of total Billed charges,63% of Total Billed Charges,1773.2,62,,1418.56,percent of total Billed Charges,62% of total BIlled charges,1801.8,63,,1441.44,percent of total Billed Charges,63% of total Billed Charges,2431,85,,1944.8,percent of total Billed Charges,85% of total Billed Charges,2288,80,,1830.4,percent of total Billed Charges,80% of total Billed Charges,1773.2,62,,1418.56,percent of total Billed Charges,62% of total Billed Charges,1801.8,63,,1441.44,percent of total Billed Charges,63% of total Billed Charges,1773.2,62,,1418.56,percent of total Billed Charges,62% of total Billed Charges,1801.8,63,,1441.44,percent of total billed charges,63% of total Billed Charges,1773.2,62,,1418.56,percent of total Billed Charges,62% of total Billed Charges,2288,80,,1830.4,percent of total Billed Charges,80% of Total Billed Charges,1773.2,62,,1418.56,percent of total Billed Charges,62% of total Billed Charges,1773.2,62,,1418.56,percent of total Billed Charges,62% of total Billed Charges,1773.2,2431,
29882 - Meniscal Repair Arthroscopy Knee,529882,CDM,360,RC,29882,HCPCS,Outpatient,,,4398,3078.6,,3518.4,80,,2814.72,percent of total Billed Charges,80% of Total Billed Charges,2770.74,63,,2216.592,percent of total Billed charges,63% of Total Billed Charges,2726.76,62,,2181.408,percent of total Billed Charges,62% of total BIlled charges,2770.74,63,,2216.592,percent of total Billed Charges,63% of total Billed Charges,3738.3,85,,2990.64,percent of total Billed Charges,85% of total Billed Charges,3518.4,80,,2814.72,percent of total Billed Charges,80% of total Billed Charges,2726.76,62,,2181.408,percent of total Billed Charges,62% of total Billed Charges,2770.74,63,,2216.592,percent of total Billed Charges,63% of total Billed Charges,2726.76,62,,2181.408,percent of total Billed Charges,62% of total Billed Charges,2770.74,63,,2216.592,percent of total billed charges,63% of total Billed Charges,2726.76,62,,2181.408,percent of total Billed Charges,62% of total Billed Charges,3518.4,80,,2814.72,percent of total Billed Charges,80% of Total Billed Charges,2726.76,62,,2181.408,percent of total Billed Charges,62% of total Billed Charges,2726.76,62,,2181.408,percent of total Billed Charges,62% of total Billed Charges,2726.76,3738.3,
15220 - Procurement Skin,515220,CDM,360,RC,15220,HCPCS,Outpatient,,,2798,1958.6,,2238.4,80,,1790.72,percent of total Billed Charges,80% of Total Billed Charges,1762.74,63,,1410.192,percent of total Billed charges,63% of Total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total BIlled charges,1762.74,63,,1410.192,percent of total Billed Charges,63% of total Billed Charges,2378.3,85,,1902.64,percent of total Billed Charges,85% of total Billed Charges,2238.4,80,,1790.72,percent of total Billed Charges,80% of total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total Billed Charges,1762.74,63,,1410.192,percent of total Billed Charges,63% of total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total Billed Charges,1762.74,63,,1410.192,percent of total billed charges,63% of total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total Billed Charges,2238.4,80,,1790.72,percent of total Billed Charges,80% of Total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total Billed Charges,1734.76,2378.3,
26045 - Release Contracture Hand,526045,CDM,360,RC,26045,HCPCS,Outpatient,,,4547,3182.9,,3637.6,80,,2910.08,percent of total Billed Charges,80% of Total Billed Charges,2864.61,63,,2291.688,percent of total Billed charges,63% of Total Billed Charges,2819.14,62,,2255.312,percent of total Billed Charges,62% of total BIlled charges,2864.61,63,,2291.688,percent of total Billed Charges,63% of total Billed Charges,3864.95,85,,3091.96,percent of total Billed Charges,85% of total Billed Charges,3637.6,80,,2910.08,percent of total Billed Charges,80% of total Billed Charges,2819.14,62,,2255.312,percent of total Billed Charges,62% of total Billed Charges,2864.61,63,,2291.688,percent of total Billed Charges,63% of total Billed Charges,2819.14,62,,2255.312,percent of total Billed Charges,62% of total Billed Charges,2864.61,63,,2291.688,percent of total billed charges,63% of total Billed Charges,2819.14,62,,2255.312,percent of total Billed Charges,62% of total Billed Charges,3637.6,80,,2910.08,percent of total Billed Charges,80% of Total Billed Charges,2819.14,62,,2255.312,percent of total Billed Charges,62% of total Billed Charges,2819.14,62,,2255.312,percent of total Billed Charges,62% of total Billed Charges,2819.14,3864.95,
69424 - Removal Tympanostomy Tubes,569424,CDM,360,RC,69424,HCPCS,Outpatient,,,2485,1739.5,,1988,80,,1590.4,percent of total Billed Charges,80% of Total Billed Charges,1565.55,63,,1252.44,percent of total Billed charges,63% of Total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total BIlled charges,1565.55,63,,1252.44,percent of total Billed Charges,63% of total Billed Charges,2112.25,85,,1689.8,percent of total Billed Charges,85% of total Billed Charges,1988,80,,1590.4,percent of total Billed Charges,80% of total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total Billed Charges,1565.55,63,,1252.44,percent of total Billed Charges,63% of total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total Billed Charges,1565.55,63,,1252.44,percent of total billed charges,63% of total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total Billed Charges,1988,80,,1590.4,percent of total Billed Charges,80% of Total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total Billed Charges,1540.7,2112.25,
67914 - Repair Ectropion,567914,CDM,360,RC,67914,HCPCS,Outpatient,,,2958,2070.6,,2366.4,80,,1893.12,percent of total Billed Charges,80% of Total Billed Charges,1863.54,63,,1490.832,percent of total Billed charges,63% of Total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total BIlled charges,1863.54,63,,1490.832,percent of total Billed Charges,63% of total Billed Charges,2514.3,85,,2011.44,percent of total Billed Charges,85% of total Billed Charges,2366.4,80,,1893.12,percent of total Billed Charges,80% of total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total Billed Charges,1863.54,63,,1490.832,percent of total Billed Charges,63% of total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total Billed Charges,1863.54,63,,1490.832,percent of total billed charges,63% of total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total Billed Charges,2366.4,80,,1893.12,percent of total Billed Charges,80% of Total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total Billed Charges,1833.96,2514.3,
28285 - Repair Hammer Toe,528285,CDM,360,RC,28285,HCPCS,Outpatient,,,3435,2404.5,,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2164.05,63,,1731.24,percent of total Billed charges,63% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total BIlled charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2919.75,85,,2335.8,percent of total Billed Charges,85% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total billed charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,2919.75,
49570 - Repair Hernia Epigastric,549570,CDM,360,RC,49570,HCPCS,Outpatient,,,5304,3712.8,,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3341.52,63,,2673.216,percent of total Billed charges,63% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total BIlled charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,4508.4,85,,3606.72,percent of total Billed Charges,85% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total billed charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,4508.4,
49550 - Repair Hernia Femoral,549550,CDM,360,RC,49550,HCPCS,Outpatient,,,5304,3712.8,,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3341.52,63,,2673.216,percent of total Billed charges,63% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total BIlled charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,4508.4,85,,3606.72,percent of total Billed Charges,85% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total billed charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,4508.4,
49650 - Repair Hernia Laparoscopy Inguinal,549650,CDM,360,RC,49650,HCPCS,Outpatient,,,7443,5210.1,,5954.4,80,,4763.52,percent of total Billed Charges,80% of Total Billed Charges,4689.09,63,,3751.272,percent of total Billed charges,63% of Total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total BIlled charges,4689.09,63,,3751.272,percent of total Billed Charges,63% of total Billed Charges,6326.55,85,,5061.24,percent of total Billed Charges,85% of total Billed Charges,5954.4,80,,4763.52,percent of total Billed Charges,80% of total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total Billed Charges,4689.09,63,,3751.272,percent of total Billed Charges,63% of total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total Billed Charges,4689.09,63,,3751.272,percent of total billed charges,63% of total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total Billed Charges,5954.4,80,,4763.52,percent of total Billed Charges,80% of Total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total Billed Charges,4614.66,6326.55,
52351 - Ureteroscopy,552351,CDM,360,RC,52351,HCPCS,Outpatient,,,4095,2866.5,,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2579.85,63,,2063.88,percent of total Billed charges,63% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total BIlled charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,3480.75,85,,2784.6,percent of total Billed Charges,85% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total billed charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,3480.75,
55540 - Varicocelectomy,555540,CDM,360,RC,55540,HCPCS,Outpatient,,,5304,3712.8,,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3341.52,63,,2673.216,percent of total Billed charges,63% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total BIlled charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,4508.4,85,,3606.72,percent of total Billed Charges,85% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total billed charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,4508.4,
10060 - I andD ABSCESS SMPL OR SNGL,510060,CDM,360,RC,10060,HCPCS,Outpatient,,,326,228.2,,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,205.38,63,,164.304,percent of total Billed charges,63% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total BIlled charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,277.1,85,,221.68,percent of total Billed Charges,85% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total billed charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,277.1,
10061 - I andD ABSCESS COMPL OR MULTIPLE,510061,CDM,360,RC,10061,HCPCS,Outpatient,,,326,228.2,,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,205.38,63,,164.304,percent of total Billed charges,63% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total BIlled charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,277.1,85,,221.68,percent of total Billed Charges,85% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total billed charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,277.1,
10140 - I andD HEMATOMA SEROMA/FLUID COLLECTN,510140,CDM,360,RC,10140,HCPCS,Outpatient,,,1724,1206.8,,1379.2,80,,1103.36,percent of total Billed Charges,80% of Total Billed Charges,1086.12,63,,868.896,percent of total Billed charges,63% of Total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total BIlled charges,1086.12,63,,868.896,percent of total Billed Charges,63% of total Billed Charges,1465.4,85,,1172.32,percent of total Billed Charges,85% of total Billed Charges,1379.2,80,,1103.36,percent of total Billed Charges,80% of total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1086.12,63,,868.896,percent of total Billed Charges,63% of total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1086.12,63,,868.896,percent of total billed charges,63% of total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1379.2,80,,1103.36,percent of total Billed Charges,80% of Total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1068.88,1465.4,
11000 - DEBRIDEMENT EXT ECZEMATOUS/INF SKIN UP TO 10% BDY SURF,511000,CDM,360,RC,11000,HCPCS,Outpatient,,,128,89.6,,102.4,80,,81.92,percent of total Billed Charges,80% of Total Billed Charges,80.64,63,,64.512,percent of total Billed charges,63% of Total Billed Charges,79.36,62,,63.488,percent of total Billed Charges,62% of total BIlled charges,80.64,63,,64.512,percent of total Billed Charges,63% of total Billed Charges,108.8,85,,87.04,percent of total Billed Charges,85% of total Billed Charges,102.4,80,,81.92,percent of total Billed Charges,80% of total Billed Charges,79.36,62,,63.488,percent of total Billed Charges,62% of total Billed Charges,80.64,63,,64.512,percent of total Billed Charges,63% of total Billed Charges,79.36,62,,63.488,percent of total Billed Charges,62% of total Billed Charges,80.64,63,,64.512,percent of total billed charges,63% of total Billed Charges,79.36,62,,63.488,percent of total Billed Charges,62% of total Billed Charges,102.4,80,,81.92,percent of total Billed Charges,80% of Total Billed Charges,79.36,62,,63.488,percent of total Billed Charges,62% of total Billed Charges,79.36,62,,63.488,percent of total Billed Charges,62% of total Billed Charges,79.36,108.8,
11005 - Debride of skin subQ tissue muscle/fascia for necrotizing soft tissue infection; abd wall;,511005,CDM,360,RC,11005,HCPCS,Outpatient,,,2423,1696.1,,1938.4,80,,1550.72,percent of total Billed Charges,80% of Total Billed Charges,1526.49,63,,1221.192,percent of total Billed charges,63% of Total Billed Charges,1502.26,62,,1201.808,percent of total Billed Charges,62% of total BIlled charges,1526.49,63,,1221.192,percent of total Billed Charges,63% of total Billed Charges,2059.55,85,,1647.64,percent of total Billed Charges,85% of total Billed Charges,1938.4,80,,1550.72,percent of total Billed Charges,80% of total Billed Charges,1502.26,62,,1201.808,percent of total Billed Charges,62% of total Billed Charges,1526.49,63,,1221.192,percent of total Billed Charges,63% of total Billed Charges,1502.26,62,,1201.808,percent of total Billed Charges,62% of total Billed Charges,1526.49,63,,1221.192,percent of total billed charges,63% of total Billed Charges,1502.26,62,,1201.808,percent of total Billed Charges,62% of total Billed Charges,1938.4,80,,1550.72,percent of total Billed Charges,80% of Total Billed Charges,1502.26,62,,1201.808,percent of total Billed Charges,62% of total Billed Charges,1502.26,62,,1201.808,percent of total Billed Charges,62% of total Billed Charges,1502.26,2059.55,
11010 - DEBRIDE INCL REMVL FOREIGN MATL AT SITE OF OPEN FX/OPEN DISLOC; SKN/SUBQ TISSUES,511010,CDM,360,RC,11010,HCPCS,Outpatient,,,1938,1356.6,,1550.4,80,,1240.32,percent of total Billed Charges,80% of Total Billed Charges,1220.94,63,,976.752,percent of total Billed charges,63% of Total Billed Charges,1201.56,62,,961.248,percent of total Billed Charges,62% of total BIlled charges,1220.94,63,,976.752,percent of total Billed Charges,63% of total Billed Charges,1647.3,85,,1317.84,percent of total Billed Charges,85% of total Billed Charges,1550.4,80,,1240.32,percent of total Billed Charges,80% of total Billed Charges,1201.56,62,,961.248,percent of total Billed Charges,62% of total Billed Charges,1220.94,63,,976.752,percent of total Billed Charges,63% of total Billed Charges,1201.56,62,,961.248,percent of total Billed Charges,62% of total Billed Charges,1220.94,63,,976.752,percent of total billed charges,63% of total Billed Charges,1201.56,62,,961.248,percent of total Billed Charges,62% of total Billed Charges,1550.4,80,,1240.32,percent of total Billed Charges,80% of Total Billed Charges,1201.56,62,,961.248,percent of total Billed Charges,62% of total Billed Charges,1201.56,62,,961.248,percent of total Billed Charges,62% of total Billed Charges,1201.56,1647.3,
11042 - DEBRIDEMNT SUBQ TISSUE 1ST 20 SQ CM OR LESS,511042,CDM,360,RC,11042,HCPCS,Outpatient,,,561,392.7,,448.8,80,,359.04,percent of total Billed Charges,80% of Total Billed Charges,353.43,63,,282.744,percent of total Billed charges,63% of Total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total BIlled charges,353.43,63,,282.744,percent of total Billed Charges,63% of total Billed Charges,476.85,85,,381.48,percent of total Billed Charges,85% of total Billed Charges,448.8,80,,359.04,percent of total Billed Charges,80% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,353.43,63,,282.744,percent of total Billed Charges,63% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,353.43,63,,282.744,percent of total billed charges,63% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,448.8,80,,359.04,percent of total Billed Charges,80% of Total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,347.82,476.85,
11043 - DEBRIDMNT MUSC AND/OR FASCIA 1ST 20 SQ CM OR LESS,511043,CDM,360,RC,11043,HCPCS,Outpatient,,,561,392.7,,448.8,80,,359.04,percent of total Billed Charges,80% of Total Billed Charges,353.43,63,,282.744,percent of total Billed charges,63% of Total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total BIlled charges,353.43,63,,282.744,percent of total Billed Charges,63% of total Billed Charges,476.85,85,,381.48,percent of total Billed Charges,85% of total Billed Charges,448.8,80,,359.04,percent of total Billed Charges,80% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,353.43,63,,282.744,percent of total Billed Charges,63% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,353.43,63,,282.744,percent of total billed charges,63% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,448.8,80,,359.04,percent of total Billed Charges,80% of Total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,347.82,476.85,
11044 - DEBRIDEMENT BONE MUSCLE  and/FASCIA 20 SQ CM/<,511044,CDM,360,RC,11044,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
11045 - Debridement subcutaneous tissue; each additional 20 sq cm or part thereof,511045,CDM,360,RC,11045,HCPCS,Outpatient,,,87,60.9,,69.6,80,,55.68,percent of total Billed Charges,80% of Total Billed Charges,54.81,63,,43.848,percent of total Billed charges,63% of Total Billed Charges,53.94,62,,43.152,percent of total Billed Charges,62% of total BIlled charges,54.81,63,,43.848,percent of total Billed Charges,63% of total Billed Charges,73.95,85,,59.16,percent of total Billed Charges,85% of total Billed Charges,69.6,80,,55.68,percent of total Billed Charges,80% of total Billed Charges,53.94,62,,43.152,percent of total Billed Charges,62% of total Billed Charges,54.81,63,,43.848,percent of total Billed Charges,63% of total Billed Charges,53.94,62,,43.152,percent of total Billed Charges,62% of total Billed Charges,54.81,63,,43.848,percent of total billed charges,63% of total Billed Charges,53.94,62,,43.152,percent of total Billed Charges,62% of total Billed Charges,69.6,80,,55.68,percent of total Billed Charges,80% of Total Billed Charges,53.94,62,,43.152,percent of total Billed Charges,62% of total Billed Charges,53.94,62,,43.152,percent of total Billed Charges,62% of total Billed Charges,53.94,73.95,
11046 - Debridement muscle and/or fascia; each add 20 sq cm or part thereof,511046,CDM,360,RC,11046,HCPCS,Outpatient,,,168,117.6,,134.4,80,,107.52,percent of total Billed Charges,80% of Total Billed Charges,105.84,63,,84.672,percent of total Billed charges,63% of Total Billed Charges,104.16,62,,83.328,percent of total Billed Charges,62% of total BIlled charges,105.84,63,,84.672,percent of total Billed Charges,63% of total Billed Charges,142.8,85,,114.24,percent of total Billed Charges,85% of total Billed Charges,134.4,80,,107.52,percent of total Billed Charges,80% of total Billed Charges,104.16,62,,83.328,percent of total Billed Charges,62% of total Billed Charges,105.84,63,,84.672,percent of total Billed Charges,63% of total Billed Charges,104.16,62,,83.328,percent of total Billed Charges,62% of total Billed Charges,105.84,63,,84.672,percent of total billed charges,63% of total Billed Charges,104.16,62,,83.328,percent of total Billed Charges,62% of total Billed Charges,134.4,80,,107.52,percent of total Billed Charges,80% of Total Billed Charges,104.16,62,,83.328,percent of total Billed Charges,62% of total Billed Charges,104.16,62,,83.328,percent of total Billed Charges,62% of total Billed Charges,104.16,142.8,
11400 - EXC BENIGN LESION INCL MARGINS TRNKARMS/LEGS EXC DIAM 0.5 CM OR LESS,511400,CDM,360,RC,11400,HCPCS,Outpatient,,,651,455.7,,520.8,80,,416.64,percent of total Billed Charges,80% of Total Billed Charges,410.13,63,,328.104,percent of total Billed charges,63% of Total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total BIlled charges,410.13,63,,328.104,percent of total Billed Charges,63% of total Billed Charges,553.35,85,,442.68,percent of total Billed Charges,85% of total Billed Charges,520.8,80,,416.64,percent of total Billed Charges,80% of total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total Billed Charges,410.13,63,,328.104,percent of total Billed Charges,63% of total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total Billed Charges,410.13,63,,328.104,percent of total billed charges,63% of total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total Billed Charges,520.8,80,,416.64,percent of total Billed Charges,80% of Total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total Billed Charges,403.62,553.35,
11422 - EXC benign lesion including margins except skin tag S/N/H/F/G; excised diameter 1.1 to 2.0,511422,CDM,360,RC,11422,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
11424 - EXC benign lesion including margins except skin tag S/N/H/F/G; excised diameter 3.1 to 4.0,511424,CDM,360,RC,11424,HCPCS,Outpatient,,,2339,1637.3,,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1473.57,63,,1178.856,percent of total Billed charges,63% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total BIlled charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1988.15,85,,1590.52,percent of total Billed Charges,85% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total billed charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,1988.15,
11440 - EXC other benign lesion including margins except skin tag F/E/EL/N/L mucous membrane; 0.5,511440,CDM,360,RC,11440,HCPCS,Outpatient,,,651,455.7,,520.8,80,,416.64,percent of total Billed Charges,80% of Total Billed Charges,410.13,63,,328.104,percent of total Billed charges,63% of Total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total BIlled charges,410.13,63,,328.104,percent of total Billed Charges,63% of total Billed Charges,553.35,85,,442.68,percent of total Billed Charges,85% of total Billed Charges,520.8,80,,416.64,percent of total Billed Charges,80% of total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total Billed Charges,410.13,63,,328.104,percent of total Billed Charges,63% of total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total Billed Charges,410.13,63,,328.104,percent of total billed charges,63% of total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total Billed Charges,520.8,80,,416.64,percent of total Billed Charges,80% of Total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total Billed Charges,403.62,553.35,
11442 - EXC other benign lesion including margins except skin tag F/E/EL/N/L mucous membrane; 1.1,511442,CDM,360,RC,11442,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
11443 - EXC FACE B9 LES MARGIN F/E/E/N/L/M 2.1-3.0 CM,511443,CDM,360,RC,11443,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
11444 - EXC other benign lesion including margins except skin tag F/E/EL/N/L mucous membrane; 3.1,511444,CDM,360,RC,11444,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
11600 - EXC malignant lesion including marginsT/A/L; excised diameter 0.5 cm or less,511600,CDM,360,RC,11600,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
11620 - Excision malignant lesion including margins scalp neck hands feet genitalia; < 0.5cm;,511620,CDM,360,RC,11620,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
11621 - EXC malignant lesion including margins S/N/H/F/G; excised diameter 0.6 to 1.0 cm,511621,CDM,360,RC,11621,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
11622 - EXC malignant lesion including margins S/N/H/F/G; excised diameter 1.1 to 2.0 cm,511622,CDM,360,RC,11622,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
11626 - EXC malignant lesion including margins S/N/H/F/G; excised diameter over 4.0 cm,511626,CDM,360,RC,11626,HCPCS,Outpatient,,,3543,2480.1,,2834.4,80,,2267.52,percent of total Billed Charges,80% of Total Billed Charges,2232.09,63,,1785.672,percent of total Billed charges,63% of Total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total BIlled charges,2232.09,63,,1785.672,percent of total Billed Charges,63% of total Billed Charges,3011.55,85,,2409.24,percent of total Billed Charges,85% of total Billed Charges,2834.4,80,,2267.52,percent of total Billed Charges,80% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2232.09,63,,1785.672,percent of total Billed Charges,63% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2232.09,63,,1785.672,percent of total billed charges,63% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2834.4,80,,2267.52,percent of total Billed Charges,80% of Total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2196.66,3011.55,
11640 - EXC malignant lesion including margins F/E/EL/N/L; excised diameter 0.5 cm or less,511640,CDM,360,RC,11640,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
11644 - EXC malignant lesion including margins F/E/EL/N/L; excised diameter 3.1 to 4.0 cm,511644,CDM,360,RC,11644,HCPCS,Outpatient,,,2339,1637.3,,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1473.57,63,,1178.856,percent of total Billed charges,63% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total BIlled charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1988.15,85,,1590.52,percent of total Billed Charges,85% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total billed charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,1988.15,
11770 - EXC of pilonidal cyst or sinus; simple,511770,CDM,360,RC,11770,HCPCS,Outpatient,,,3543,2480.1,,2834.4,80,,2267.52,percent of total Billed Charges,80% of Total Billed Charges,2232.09,63,,1785.672,percent of total Billed charges,63% of Total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total BIlled charges,2232.09,63,,1785.672,percent of total Billed Charges,63% of total Billed Charges,3011.55,85,,2409.24,percent of total Billed Charges,85% of total Billed Charges,2834.4,80,,2267.52,percent of total Billed Charges,80% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2232.09,63,,1785.672,percent of total Billed Charges,63% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2232.09,63,,1785.672,percent of total billed charges,63% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2834.4,80,,2267.52,percent of total Billed Charges,80% of Total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2196.66,3011.55,
15220 - FULL THICKNESS SKIN GRAFTINCLUDING DIRECT CLOSURE OF DONOR SITE SCALP ARMSOR LEGS20cM<,515220,CDM,360,RC,15220,HCPCS,Outpatient,,,2798,1958.6,,2238.4,80,,1790.72,percent of total Billed Charges,80% of Total Billed Charges,1762.74,63,,1410.192,percent of total Billed charges,63% of Total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total BIlled charges,1762.74,63,,1410.192,percent of total Billed Charges,63% of total Billed Charges,2378.3,85,,1902.64,percent of total Billed Charges,85% of total Billed Charges,2238.4,80,,1790.72,percent of total Billed Charges,80% of total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total Billed Charges,1762.74,63,,1410.192,percent of total Billed Charges,63% of total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total Billed Charges,1762.74,63,,1410.192,percent of total billed charges,63% of total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total Billed Charges,2238.4,80,,1790.72,percent of total Billed Charges,80% of Total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total Billed Charges,1734.76,2378.3,
16020 - Dressings and/or debridement of partial-thickness burns initial or subsequent; small (less th,51009,CDM,360,RC,16020,HCPCS,Outpatient,,,301,210.7,,240.8,80,,192.64,percent of total Billed Charges,80% of Total Billed Charges,189.63,63,,151.704,percent of total Billed charges,63% of Total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total BIlled charges,189.63,63,,151.704,percent of total Billed Charges,63% of total Billed Charges,255.85,85,,204.68,percent of total Billed Charges,85% of total Billed Charges,240.8,80,,192.64,percent of total Billed Charges,80% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,189.63,63,,151.704,percent of total Billed Charges,63% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,189.63,63,,151.704,percent of total billed charges,63% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,240.8,80,,192.64,percent of total Billed Charges,80% of Total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,186.62,255.85,
19000 - Puncture aspiration of cyst of breast;,519000,CDM,360,RC,19000,HCPCS,Outpatient,,,840,588,,672,80,,537.6,percent of total Billed Charges,80% of Total Billed Charges,529.2,63,,423.36,percent of total Billed charges,63% of Total Billed Charges,520.8,62,,416.64,percent of total Billed Charges,62% of total BIlled charges,529.2,63,,423.36,percent of total Billed Charges,63% of total Billed Charges,714,85,,571.2,percent of total Billed Charges,85% of total Billed Charges,672,80,,537.6,percent of total Billed Charges,80% of total Billed Charges,520.8,62,,416.64,percent of total Billed Charges,62% of total Billed Charges,529.2,63,,423.36,percent of total Billed Charges,63% of total Billed Charges,520.8,62,,416.64,percent of total Billed Charges,62% of total Billed Charges,529.2,63,,423.36,percent of total billed charges,63% of total Billed Charges,520.8,62,,416.64,percent of total Billed Charges,62% of total Billed Charges,672,80,,537.6,percent of total Billed Charges,80% of Total Billed Charges,520.8,62,,416.64,percent of total Billed Charges,62% of total Billed Charges,520.8,62,,416.64,percent of total Billed Charges,62% of total Billed Charges,520.8,714,
19100 - Biopsy of breast; percutaneous needle core not using imaging guidance;,519100,CDM,360,RC,19100,HCPCS,Outpatient,,,839,587.3,,671.2,80,,536.96,percent of total Billed Charges,80% of Total Billed Charges,528.57,63,,422.856,percent of total Billed charges,63% of Total Billed Charges,520.18,62,,416.144,percent of total Billed Charges,62% of total BIlled charges,528.57,63,,422.856,percent of total Billed Charges,63% of total Billed Charges,713.15,85,,570.52,percent of total Billed Charges,85% of total Billed Charges,671.2,80,,536.96,percent of total Billed Charges,80% of total Billed Charges,520.18,62,,416.144,percent of total Billed Charges,62% of total Billed Charges,528.57,63,,422.856,percent of total Billed Charges,63% of total Billed Charges,520.18,62,,416.144,percent of total Billed Charges,62% of total Billed Charges,528.57,63,,422.856,percent of total billed charges,63% of total Billed Charges,520.18,62,,416.144,percent of total Billed Charges,62% of total Billed Charges,671.2,80,,536.96,percent of total Billed Charges,80% of Total Billed Charges,520.18,62,,416.144,percent of total Billed Charges,62% of total Billed Charges,520.18,62,,416.144,percent of total Billed Charges,62% of total Billed Charges,520.18,713.15,
19101 - Biopsy of breast; open incisional,519101,CDM,360,RC,19101,HCPCS,Outpatient,,,4028,2819.6,,3222.4,80,,2577.92,percent of total Billed Charges,80% of Total Billed Charges,2537.64,63,,2030.112,percent of total Billed charges,63% of Total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total BIlled charges,2537.64,63,,2030.112,percent of total Billed Charges,63% of total Billed Charges,3423.8,85,,2739.04,percent of total Billed Charges,85% of total Billed Charges,3222.4,80,,2577.92,percent of total Billed Charges,80% of total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total Billed Charges,2537.64,63,,2030.112,percent of total Billed Charges,63% of total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total Billed Charges,2537.64,63,,2030.112,percent of total billed charges,63% of total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total Billed Charges,3222.4,80,,2577.92,percent of total Billed Charges,80% of Total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total Billed Charges,2497.36,3423.8,
19120 - EXC of cyst fibroadenoma or other tumor aberrant breast tissue duct lesion nipple or areo,519120,CDM,360,RC,19120,HCPCS,Outpatient,,,4028,2819.6,,3222.4,80,,2577.92,percent of total Billed Charges,80% of Total Billed Charges,2537.64,63,,2030.112,percent of total Billed charges,63% of Total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total BIlled charges,2537.64,63,,2030.112,percent of total Billed Charges,63% of total Billed Charges,3423.8,85,,2739.04,percent of total Billed Charges,85% of total Billed Charges,3222.4,80,,2577.92,percent of total Billed Charges,80% of total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total Billed Charges,2537.64,63,,2030.112,percent of total Billed Charges,63% of total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total Billed Charges,2537.64,63,,2030.112,percent of total billed charges,63% of total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total Billed Charges,3222.4,80,,2577.92,percent of total Billed Charges,80% of Total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total Billed Charges,2497.36,62,,1997.888,percent of total Billed Charges,62% of total Billed Charges,2497.36,3423.8,
21011 - Excision tumor soft tissue of face or scalp subcutaneous; less than 2 cm;,521011,CDM,360,RC,21011,HCPCS,Outpatient,,,801,560.7,,640.8,80,,512.64,percent of total Billed Charges,80% of Total Billed Charges,504.63,63,,403.704,percent of total Billed charges,63% of Total Billed Charges,496.62,62,,397.296,percent of total Billed Charges,62% of total BIlled charges,504.63,63,,403.704,percent of total Billed Charges,63% of total Billed Charges,680.85,85,,544.68,percent of total Billed Charges,85% of total Billed Charges,640.8,80,,512.64,percent of total Billed Charges,80% of total Billed Charges,496.62,62,,397.296,percent of total Billed Charges,62% of total Billed Charges,504.63,63,,403.704,percent of total Billed Charges,63% of total Billed Charges,496.62,62,,397.296,percent of total Billed Charges,62% of total Billed Charges,504.63,63,,403.704,percent of total billed charges,63% of total Billed Charges,496.62,62,,397.296,percent of total Billed Charges,62% of total Billed Charges,640.8,80,,512.64,percent of total Billed Charges,80% of Total Billed Charges,496.62,62,,397.296,percent of total Billed Charges,62% of total Billed Charges,496.62,62,,397.296,percent of total Billed Charges,62% of total Billed Charges,496.62,680.85,
21012 - Excision tumor soft tissue of face or scalp subcutaneous; 2 cm or greater;,521012,CDM,360,RC,21012,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
21550 - Biopsy soft tissue of neck or thorax;,521550,CDM,360,RC,21550,HCPCS,Outpatient,,,2339,1637.3,,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1473.57,63,,1178.856,percent of total Billed charges,63% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total BIlled charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1988.15,85,,1590.52,percent of total Billed Charges,85% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total billed charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,1988.15,
21555 - EXC TUMOR SFT TISSUE NECK/ANTERIOR THORAX SUBCUT < 3CM,521555,CDM,360,RC,21555,HCPCS,Outpatient,,,2339,1637.3,,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1473.57,63,,1178.856,percent of total Billed charges,63% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total BIlled charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1988.15,85,,1590.52,percent of total Billed Charges,85% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total billed charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,1988.15,
21920 - BIOPSY SOFT TISSUE OF BACK OR FLANK; SUPERFICIAL;,521920,CDM,360,RC,21920,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
21930 - EXC tumor soft tissue of back or flank subcutaneous; less than 3 cm,521930,CDM,360,RC,21930,HCPCS,Outpatient,,,2339,1637.3,,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1473.57,63,,1178.856,percent of total Billed charges,63% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total BIlled charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1988.15,85,,1590.52,percent of total Billed Charges,85% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total billed charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,1988.15,
22900 - EXC TUMOR SOFT TISSUE ABDOMINAL WALL LESS THAN 5 CM,522900,CDM,360,RC,22900,HCPCS,Outpatient,,,3543,2480.1,,2834.4,80,,2267.52,percent of total Billed Charges,80% of Total Billed Charges,2232.09,63,,1785.672,percent of total Billed charges,63% of Total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total BIlled charges,2232.09,63,,1785.672,percent of total Billed Charges,63% of total Billed Charges,3011.55,85,,2409.24,percent of total Billed Charges,85% of total Billed Charges,2834.4,80,,2267.52,percent of total Billed Charges,80% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2232.09,63,,1785.672,percent of total Billed Charges,63% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2232.09,63,,1785.672,percent of total billed charges,63% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2834.4,80,,2267.52,percent of total Billed Charges,80% of Total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2196.66,3011.55,
24076 - EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW AREA SUBFASCIAL LESS THAN 5 CM,524076,CDM,360,RC,24076,HCPCS,Outpatient,,,2339,1637.3,,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1473.57,63,,1178.856,percent of total Billed charges,63% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total BIlled charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1988.15,85,,1590.52,percent of total Billed Charges,85% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total billed charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,1988.15,
25065 - BX SOFT TISSUE FOREARM/WRIST SUPERFICIAL,525065,CDM,360,RC,25065,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
25076 - EXC TUMOR SOFT TISSUE FOREARM/WRIST AREA SUBFASCIAL LESS THAN 3 CM,525076,CDM,360,RC,25076,HCPCS,Outpatient,,,5262,3683.4,,4209.6,80,,3367.68,percent of total Billed Charges,80% of Total Billed Charges,3315.06,63,,2652.048,percent of total Billed charges,63% of Total Billed Charges,3262.44,62,,2609.952,percent of total Billed Charges,62% of total BIlled charges,3315.06,63,,2652.048,percent of total Billed Charges,63% of total Billed Charges,4472.7,85,,3578.16,percent of total Billed Charges,85% of total Billed Charges,4209.6,80,,3367.68,percent of total Billed Charges,80% of total Billed Charges,3262.44,62,,2609.952,percent of total Billed Charges,62% of total Billed Charges,3315.06,63,,2652.048,percent of total Billed Charges,63% of total Billed Charges,3262.44,62,,2609.952,percent of total Billed Charges,62% of total Billed Charges,3315.06,63,,2652.048,percent of total billed charges,63% of total Billed Charges,3262.44,62,,2609.952,percent of total Billed Charges,62% of total Billed Charges,4209.6,80,,3367.68,percent of total Billed Charges,80% of Total Billed Charges,3262.44,62,,2609.952,percent of total Billed Charges,62% of total Billed Charges,3262.44,62,,2609.952,percent of total Billed Charges,62% of total Billed Charges,3262.44,4472.7,
25111 - OR EXC OF GANGLUION CYST,525111,CDM,360,RC,25111,HCPCS,Outpatient,,,3345,2341.5,,2676,80,,2140.8,percent of total Billed Charges,80% of Total Billed Charges,2107.35,63,,1685.88,percent of total Billed charges,63% of Total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total BIlled charges,2107.35,63,,1685.88,percent of total Billed Charges,63% of total Billed Charges,2843.25,85,,2274.6,percent of total Billed Charges,85% of total Billed Charges,2676,80,,2140.8,percent of total Billed Charges,80% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2107.35,63,,1685.88,percent of total Billed Charges,63% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2107.35,63,,1685.88,percent of total billed charges,63% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2676,80,,2140.8,percent of total Billed Charges,80% of Total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2073.9,2843.25,
26160 - Excision of lesion of tendon sheath or joint capsule hand or finger;,526160,CDM,360,RC,26160,HCPCS,Outpatient,,,2552,1786.4,,2041.6,80,,1633.28,percent of total Billed Charges,80% of Total Billed Charges,1607.76,63,,1286.208,percent of total Billed charges,63% of Total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total BIlled charges,1607.76,63,,1286.208,percent of total Billed Charges,63% of total Billed Charges,2169.2,85,,1735.36,percent of total Billed Charges,85% of total Billed Charges,2041.6,80,,1633.28,percent of total Billed Charges,80% of total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total Billed Charges,1607.76,63,,1286.208,percent of total Billed Charges,63% of total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total Billed Charges,1607.76,63,,1286.208,percent of total billed charges,63% of total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total Billed Charges,2041.6,80,,1633.28,percent of total Billed Charges,80% of Total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total Billed Charges,1582.24,2169.2,
26990 - Incision and drainage pelvis or hip joint area; deep abscess or hematoma;,526990,CDM,360,RC,26990,HCPCS,Outpatient,,,3345,2341.5,,2676,80,,2140.8,percent of total Billed Charges,80% of Total Billed Charges,2107.35,63,,1685.88,percent of total Billed charges,63% of Total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total BIlled charges,2107.35,63,,1685.88,percent of total Billed Charges,63% of total Billed Charges,2843.25,85,,2274.6,percent of total Billed Charges,85% of total Billed Charges,2676,80,,2140.8,percent of total Billed Charges,80% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2107.35,63,,1685.88,percent of total Billed Charges,63% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2107.35,63,,1685.88,percent of total billed charges,63% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2676,80,,2140.8,percent of total Billed Charges,80% of Total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2073.9,2843.25,
27047 - Excision tumor soft tissue of pelvis and hip area subcutaneous; less than 3 cm;,527047,CDM,360,RC,27047,HCPCS,Outpatient,,,2339,1637.3,,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1473.57,63,,1178.856,percent of total Billed charges,63% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total BIlled charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1988.15,85,,1590.52,percent of total Billed Charges,85% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total billed charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,1988.15,
27301 - INCISION AND DRAINAGE OF DEEP ABSCESS OF KNEE REGION,527301,CDM,360,RC,27301,HCPCS,Outpatient,,,3202,2241.4,,2561.6,80,,2049.28,percent of total Billed Charges,80% of Total Billed Charges,2017.26,63,,1613.808,percent of total Billed charges,63% of Total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total BIlled charges,2017.26,63,,1613.808,percent of total Billed Charges,63% of total Billed Charges,2721.7,85,,2177.36,percent of total Billed Charges,85% of total Billed Charges,2561.6,80,,2049.28,percent of total Billed Charges,80% of total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,2017.26,63,,1613.808,percent of total Billed Charges,63% of total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,2017.26,63,,1613.808,percent of total billed charges,63% of total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,2561.6,80,,2049.28,percent of total Billed Charges,80% of Total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,1985.24,2721.7,
27324 - Biopsy soft tissue of thigh or knee area; deep (subfascial or intramuscular);,527324,CDM,360,RC,27324,HCPCS,Outpatient,,,3543,2480.1,,2834.4,80,,2267.52,percent of total Billed Charges,80% of Total Billed Charges,2232.09,63,,1785.672,percent of total Billed charges,63% of Total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total BIlled charges,2232.09,63,,1785.672,percent of total Billed Charges,63% of total Billed Charges,3011.55,85,,2409.24,percent of total Billed Charges,85% of total Billed Charges,2834.4,80,,2267.52,percent of total Billed Charges,80% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2232.09,63,,1785.672,percent of total Billed Charges,63% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2232.09,63,,1785.672,percent of total billed charges,63% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2834.4,80,,2267.52,percent of total Billed Charges,80% of Total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2196.66,3011.55,
27340 - Excision prepatellar bursa;,527340,CDM,360,RC,27340,HCPCS,Outpatient,,,3345,2341.5,,2676,80,,2140.8,percent of total Billed Charges,80% of Total Billed Charges,2107.35,63,,1685.88,percent of total Billed charges,63% of Total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total BIlled charges,2107.35,63,,1685.88,percent of total Billed Charges,63% of total Billed Charges,2843.25,85,,2274.6,percent of total Billed Charges,85% of total Billed Charges,2676,80,,2140.8,percent of total Billed Charges,80% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2107.35,63,,1685.88,percent of total Billed Charges,63% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2107.35,63,,1685.88,percent of total billed charges,63% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2676,80,,2140.8,percent of total Billed Charges,80% of Total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2073.9,2843.25,
27345 - Excision of synovial cyst of popliteal space (eg Baker's cyst);,527345,CDM,360,RC,27345,HCPCS,Outpatient,,,3345,2341.5,,2676,80,,2140.8,percent of total Billed Charges,80% of Total Billed Charges,2107.35,63,,1685.88,percent of total Billed charges,63% of Total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total BIlled charges,2107.35,63,,1685.88,percent of total Billed Charges,63% of total Billed Charges,2843.25,85,,2274.6,percent of total Billed Charges,85% of total Billed Charges,2676,80,,2140.8,percent of total Billed Charges,80% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2107.35,63,,1685.88,percent of total Billed Charges,63% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2107.35,63,,1685.88,percent of total billed charges,63% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2676,80,,2140.8,percent of total Billed Charges,80% of Total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2073.9,2843.25,
27603 - Incision and drainage leg or ankle; deep abscess or hematoma;,527603,CDM,360,RC,27603,HCPCS,Outpatient,,,3202,2241.4,,2561.6,80,,2049.28,percent of total Billed Charges,80% of Total Billed Charges,2017.26,63,,1613.808,percent of total Billed charges,63% of Total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total BIlled charges,2017.26,63,,1613.808,percent of total Billed Charges,63% of total Billed Charges,2721.7,85,,2177.36,percent of total Billed Charges,85% of total Billed Charges,2561.6,80,,2049.28,percent of total Billed Charges,80% of total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,2017.26,63,,1613.808,percent of total Billed Charges,63% of total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,2017.26,63,,1613.808,percent of total billed charges,63% of total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,2561.6,80,,2049.28,percent of total Billed Charges,80% of Total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,1985.24,2721.7,
27630 - Excision of lesion of tendon sheath or capsule (eg cyst or ganglion) leg and/or ankle;,527630,CDM,360,RC,27630,HCPCS,Outpatient,,,3345,2341.5,,2676,80,,2140.8,percent of total Billed Charges,80% of Total Billed Charges,2107.35,63,,1685.88,percent of total Billed charges,63% of Total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total BIlled charges,2107.35,63,,1685.88,percent of total Billed Charges,63% of total Billed Charges,2843.25,85,,2274.6,percent of total Billed Charges,85% of total Billed Charges,2676,80,,2140.8,percent of total Billed Charges,80% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2107.35,63,,1685.88,percent of total Billed Charges,63% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2107.35,63,,1685.88,percent of total billed charges,63% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2676,80,,2140.8,percent of total Billed Charges,80% of Total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2073.9,2843.25,
28060 - Fasciectomy plantar fascia; partial (separate procedure);,528060,CDM,360,RC,28060,HCPCS,Outpatient,,,3435,2404.5,,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2164.05,63,,1731.24,percent of total Billed charges,63% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total BIlled charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2919.75,85,,2335.8,percent of total Billed Charges,85% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total billed charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,2919.75,
28090 - Excision of lesion tendon tendon sheath or capsule (including synovectomy); foot;,528090,CDM,360,RC,28090,HCPCS,Outpatient,,,3435,2404.5,,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2164.05,63,,1731.24,percent of total Billed charges,63% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total BIlled charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2919.75,85,,2335.8,percent of total Billed Charges,85% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total billed charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,2919.75,
28092 - Excision of lesion tendon tendon sheath or capsule (including synovectomy); toe(s) each;,528092,CDM,360,RC,28092,HCPCS,Outpatient,,,3435,2404.5,,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2164.05,63,,1731.24,percent of total Billed charges,63% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total BIlled charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2919.75,85,,2335.8,percent of total Billed Charges,85% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total billed charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,2919.75,
28108 - Excision or curettage of bone cyst or benign tumor phalanges of foot;,528108,CDM,360,RC,28108,HCPCS,Outpatient,,,3435,2404.5,,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2164.05,63,,1731.24,percent of total Billed charges,63% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total BIlled charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2919.75,85,,2335.8,percent of total Billed Charges,85% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total billed charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,2919.75,
28111 - Ostectomy complete excision; first metatarsal head;,528111,CDM,360,RC,28111,HCPCS,Outpatient,,,3435,2404.5,,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2164.05,63,,1731.24,percent of total Billed charges,63% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total BIlled charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2919.75,85,,2335.8,percent of total Billed Charges,85% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total billed charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,2919.75,
28122 - Partial excision of bone; tarsal or metatarsal bone except talus or calcaneus;,528122,CDM,360,RC,28122,HCPCS,Outpatient,,,3570,2499,,2856,80,,2284.8,percent of total Billed Charges,80% of Total Billed Charges,2249.1,63,,1799.28,percent of total Billed charges,63% of Total Billed Charges,2213.4,62,,1770.72,percent of total Billed Charges,62% of total BIlled charges,2249.1,63,,1799.28,percent of total Billed Charges,63% of total Billed Charges,3034.5,85,,2427.6,percent of total Billed Charges,85% of total Billed Charges,2856,80,,2284.8,percent of total Billed Charges,80% of total Billed Charges,2213.4,62,,1770.72,percent of total Billed Charges,62% of total Billed Charges,2249.1,63,,1799.28,percent of total Billed Charges,63% of total Billed Charges,2213.4,62,,1770.72,percent of total Billed Charges,62% of total Billed Charges,2249.1,63,,1799.28,percent of total billed charges,63% of total Billed Charges,2213.4,62,,1770.72,percent of total Billed Charges,62% of total Billed Charges,2856,80,,2284.8,percent of total Billed Charges,80% of Total Billed Charges,2213.4,62,,1770.72,percent of total Billed Charges,62% of total Billed Charges,2213.4,62,,1770.72,percent of total Billed Charges,62% of total Billed Charges,2213.4,3034.5,
28124 - Partial excision of bone; phalanx of toe;,528124,CDM,360,RC,28124,HCPCS,Outpatient,,,3435,2404.5,,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2164.05,63,,1731.24,percent of total Billed charges,63% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total BIlled charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2919.75,85,,2335.8,percent of total Billed Charges,85% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total billed charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,2919.75,
28160 - Hemiphalangectomy or interphalangeal joint excision toe proximal end of phalanx each;,528160,CDM,360,RC,28160,HCPCS,Outpatient,,,3435,2404.5,,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2164.05,63,,1731.24,percent of total Billed charges,63% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total BIlled charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2919.75,85,,2335.8,percent of total Billed Charges,85% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total billed charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,2919.75,
28270 - Capsulotomy; metatarsophalangeal joint with or without tenorrhaphy each joint;,528270,CDM,360,RC,28270,HCPCS,Outpatient,,,4880,3416,,3904,80,,3123.2,percent of total Billed Charges,80% of Total Billed Charges,3074.4,63,,2459.52,percent of total Billed charges,63% of Total Billed Charges,3025.6,62,,2420.48,percent of total Billed Charges,62% of total BIlled charges,3074.4,63,,2459.52,percent of total Billed Charges,63% of total Billed Charges,4148,85,,3318.4,percent of total Billed Charges,85% of total Billed Charges,3904,80,,3123.2,percent of total Billed Charges,80% of total Billed Charges,3025.6,62,,2420.48,percent of total Billed Charges,62% of total Billed Charges,3074.4,63,,2459.52,percent of total Billed Charges,63% of total Billed Charges,3025.6,62,,2420.48,percent of total Billed Charges,62% of total Billed Charges,3074.4,63,,2459.52,percent of total billed charges,63% of total Billed Charges,3025.6,62,,2420.48,percent of total Billed Charges,62% of total Billed Charges,3904,80,,3123.2,percent of total Billed Charges,80% of Total Billed Charges,3025.6,62,,2420.48,percent of total Billed Charges,62% of total Billed Charges,3025.6,62,,2420.48,percent of total Billed Charges,62% of total Billed Charges,3025.6,4148,
28285 - CORRECTION HAMMERTOE,528285,CDM,360,RC,28285,HCPCS,Outpatient,,,3435,2404.5,,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2164.05,63,,1731.24,percent of total Billed charges,63% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total BIlled charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2919.75,85,,2335.8,percent of total Billed Charges,85% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total Billed Charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2164.05,63,,1731.24,percent of total billed charges,63% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2748,80,,2198.4,percent of total Billed Charges,80% of Total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,62,,1703.76,percent of total Billed Charges,62% of total Billed Charges,2129.7,2919.75,
37609 - Ligation or biopsy temporal artery;,537609,CDM,360,RC,37609,HCPCS,Outpatient,,,2339,1637.3,,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1473.57,63,,1178.856,percent of total Billed charges,63% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total BIlled charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1988.15,85,,1590.52,percent of total Billed Charges,85% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total billed charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,1988.15,
38500 - Biopsy or EXC of lymph node(s); open superficial,538500,CDM,360,RC,38500,HCPCS,Outpatient,,,4135,2894.5,,3308,80,,2646.4,percent of total Billed Charges,80% of Total Billed Charges,2605.05,63,,2084.04,percent of total Billed charges,63% of Total Billed Charges,2563.7,62,,2050.96,percent of total Billed Charges,62% of total BIlled charges,2605.05,63,,2084.04,percent of total Billed Charges,63% of total Billed Charges,3514.75,85,,2811.8,percent of total Billed Charges,85% of total Billed Charges,3308,80,,2646.4,percent of total Billed Charges,80% of total Billed Charges,2563.7,62,,2050.96,percent of total Billed Charges,62% of total Billed Charges,2605.05,63,,2084.04,percent of total Billed Charges,63% of total Billed Charges,2563.7,62,,2050.96,percent of total Billed Charges,62% of total Billed Charges,2605.05,63,,2084.04,percent of total billed charges,63% of total Billed Charges,2563.7,62,,2050.96,percent of total Billed Charges,62% of total Billed Charges,3308,80,,2646.4,percent of total Billed Charges,80% of Total Billed Charges,2563.7,62,,2050.96,percent of total Billed Charges,62% of total Billed Charges,2563.7,62,,2050.96,percent of total Billed Charges,62% of total Billed Charges,2563.7,3514.75,
40812 - Excision of lesion of mucosa and submucosa vestibule of mouth; with simple repair;,540812,CDM,360,RC,40812,HCPCS,Outpatient,,,2485,1739.5,,1988,80,,1590.4,percent of total Billed Charges,80% of Total Billed Charges,1565.55,63,,1252.44,percent of total Billed charges,63% of Total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total BIlled charges,1565.55,63,,1252.44,percent of total Billed Charges,63% of total Billed Charges,2112.25,85,,1689.8,percent of total Billed Charges,85% of total Billed Charges,1988,80,,1590.4,percent of total Billed Charges,80% of total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total Billed Charges,1565.55,63,,1252.44,percent of total Billed Charges,63% of total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total Billed Charges,1565.55,63,,1252.44,percent of total billed charges,63% of total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total Billed Charges,1988,80,,1590.4,percent of total Billed Charges,80% of Total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total Billed Charges,1540.7,62,,1232.56,percent of total Billed Charges,62% of total Billed Charges,1540.7,2112.25,
41114 - Excision of lesion of tongue with closure; with local tongue flap;,541114,CDM,360,RC,41114,HCPCS,Outpatient,,,3793,2655.1,,3034.4,80,,2427.52,percent of total Billed Charges,80% of Total Billed Charges,2389.59,63,,1911.672,percent of total Billed charges,63% of Total Billed Charges,2351.66,62,,1881.328,percent of total Billed Charges,62% of total BIlled charges,2389.59,63,,1911.672,percent of total Billed Charges,63% of total Billed Charges,3224.05,85,,2579.24,percent of total Billed Charges,85% of total Billed Charges,3034.4,80,,2427.52,percent of total Billed Charges,80% of total Billed Charges,2351.66,62,,1881.328,percent of total Billed Charges,62% of total Billed Charges,2389.59,63,,1911.672,percent of total Billed Charges,63% of total Billed Charges,2351.66,62,,1881.328,percent of total Billed Charges,62% of total Billed Charges,2389.59,63,,1911.672,percent of total billed charges,63% of total Billed Charges,2351.66,62,,1881.328,percent of total Billed Charges,62% of total Billed Charges,3034.4,80,,2427.52,percent of total Billed Charges,80% of Total Billed Charges,2351.66,62,,1881.328,percent of total Billed Charges,62% of total Billed Charges,2351.66,62,,1881.328,percent of total Billed Charges,62% of total Billed Charges,2351.66,3224.05,
42440 - Excision of submandibular (submaxillary) gland;,542440,CDM,360,RC,42440,HCPCS,Outpatient,,,7273,5091.1,,5818.4,80,,4654.72,percent of total Billed Charges,80% of Total Billed Charges,4581.99,63,,3665.592,percent of total Billed charges,63% of Total Billed Charges,4509.26,62,,3607.408,percent of total Billed Charges,62% of total BIlled charges,4581.99,63,,3665.592,percent of total Billed Charges,63% of total Billed Charges,6182.05,85,,4945.64,percent of total Billed Charges,85% of total Billed Charges,5818.4,80,,4654.72,percent of total Billed Charges,80% of total Billed Charges,4509.26,62,,3607.408,percent of total Billed Charges,62% of total Billed Charges,4581.99,63,,3665.592,percent of total Billed Charges,63% of total Billed Charges,4509.26,62,,3607.408,percent of total Billed Charges,62% of total Billed Charges,4581.99,63,,3665.592,percent of total billed charges,63% of total Billed Charges,4509.26,62,,3607.408,percent of total Billed Charges,62% of total Billed Charges,5818.4,80,,4654.72,percent of total Billed Charges,80% of Total Billed Charges,4509.26,62,,3607.408,percent of total Billed Charges,62% of total Billed Charges,4509.26,62,,3607.408,percent of total Billed Charges,62% of total Billed Charges,4509.26,6182.05,
43235 - EGD FLEX TRANSORAL DX W/BX,50240,CDM,360,RC,43235,HCPCS,Outpatient,,,1368,957.6,,1094.4,80,,875.52,percent of total Billed Charges,80% of Total Billed Charges,861.84,63,,689.472,percent of total Billed charges,63% of Total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total BIlled charges,861.84,63,,689.472,percent of total Billed Charges,63% of total Billed Charges,1162.8,85,,930.24,percent of total Billed Charges,85% of total Billed Charges,1094.4,80,,875.52,percent of total Billed Charges,80% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,861.84,63,,689.472,percent of total Billed Charges,63% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,861.84,63,,689.472,percent of total billed charges,63% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,1094.4,80,,875.52,percent of total Billed Charges,80% of Total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,848.16,1162.8,
43236 - EGD FLEX TRANSORAL W/DIRECT SUBMUCOSAL INJ,543236,CDM,360,RC,43236,HCPCS,Outpatient,,,536,375.2,,428.8,80,,343.04,percent of total Billed Charges,80% of Total Billed Charges,337.68,63,,270.144,percent of total Billed charges,63% of Total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total BIlled charges,337.68,63,,270.144,percent of total Billed Charges,63% of total Billed Charges,455.6,85,,364.48,percent of total Billed Charges,85% of total Billed Charges,428.8,80,,343.04,percent of total Billed Charges,80% of total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total Billed Charges,337.68,63,,270.144,percent of total Billed Charges,63% of total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total Billed Charges,337.68,63,,270.144,percent of total billed charges,63% of total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total Billed Charges,428.8,80,,343.04,percent of total Billed Charges,80% of Total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total Billed Charges,332.32,455.6,
43239 - EGD FLEX TRANSORAL W/BX SINGLE/MULT,50241,CDM,360,RC,43239,HCPCS,Outpatient,,,1368,957.6,,1094.4,80,,875.52,percent of total Billed Charges,80% of Total Billed Charges,861.84,63,,689.472,percent of total Billed charges,63% of Total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total BIlled charges,861.84,63,,689.472,percent of total Billed Charges,63% of total Billed Charges,1162.8,85,,930.24,percent of total Billed Charges,85% of total Billed Charges,1094.4,80,,875.52,percent of total Billed Charges,80% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,861.84,63,,689.472,percent of total Billed Charges,63% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,861.84,63,,689.472,percent of total billed charges,63% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,1094.4,80,,875.52,percent of total Billed Charges,80% of Total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,848.16,1162.8,
43245 - EGD FLEX TRANSORAL W/DILATION GASTRIC/DUODENAL STRICTURES,543245,CDM,360,RC,43245,HCPCS,Outpatient,,,2068,1447.6,,1654.4,80,,1323.52,percent of total Billed Charges,80% of Total Billed Charges,1302.84,63,,1042.272,percent of total Billed charges,63% of Total Billed Charges,1282.16,62,,1025.728,percent of total Billed Charges,62% of total BIlled charges,1302.84,63,,1042.272,percent of total Billed Charges,63% of total Billed Charges,1757.8,85,,1406.24,percent of total Billed Charges,85% of total Billed Charges,1654.4,80,,1323.52,percent of total Billed Charges,80% of total Billed Charges,1282.16,62,,1025.728,percent of total Billed Charges,62% of total Billed Charges,1302.84,63,,1042.272,percent of total Billed Charges,63% of total Billed Charges,1282.16,62,,1025.728,percent of total Billed Charges,62% of total Billed Charges,1302.84,63,,1042.272,percent of total billed charges,63% of total Billed Charges,1282.16,62,,1025.728,percent of total Billed Charges,62% of total Billed Charges,1654.4,80,,1323.52,percent of total Billed Charges,80% of Total Billed Charges,1282.16,62,,1025.728,percent of total Billed Charges,62% of total Billed Charges,1282.16,62,,1025.728,percent of total Billed Charges,62% of total Billed Charges,1282.16,1757.8,
43246 - EGD FLEX TRANSORAL W/DIRECTED PLCMNT PERC GASTROSTOMY TUBE,50242,CDM,360,RC,43246,HCPCS,Outpatient,,,2068,1447.6,,1654.4,80,,1323.52,percent of total Billed Charges,80% of Total Billed Charges,1302.84,63,,1042.272,percent of total Billed charges,63% of Total Billed Charges,1282.16,62,,1025.728,percent of total Billed Charges,62% of total BIlled charges,1302.84,63,,1042.272,percent of total Billed Charges,63% of total Billed Charges,1757.8,85,,1406.24,percent of total Billed Charges,85% of total Billed Charges,1654.4,80,,1323.52,percent of total Billed Charges,80% of total Billed Charges,1282.16,62,,1025.728,percent of total Billed Charges,62% of total Billed Charges,1302.84,63,,1042.272,percent of total Billed Charges,63% of total Billed Charges,1282.16,62,,1025.728,percent of total Billed Charges,62% of total Billed Charges,1302.84,63,,1042.272,percent of total billed charges,63% of total Billed Charges,1282.16,62,,1025.728,percent of total Billed Charges,62% of total Billed Charges,1654.4,80,,1323.52,percent of total Billed Charges,80% of Total Billed Charges,1282.16,62,,1025.728,percent of total Billed Charges,62% of total Billed Charges,1282.16,62,,1025.728,percent of total Billed Charges,62% of total Billed Charges,1282.16,1757.8,
43247 - Esophagogastroduodenoscopy flexible transoral; with removal of foreign body(s),543247,CDM,360,RC,43247,HCPCS,Outpatient,,,1368,957.6,,1094.4,80,,875.52,percent of total Billed Charges,80% of Total Billed Charges,861.84,63,,689.472,percent of total Billed charges,63% of Total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total BIlled charges,861.84,63,,689.472,percent of total Billed Charges,63% of total Billed Charges,1162.8,85,,930.24,percent of total Billed Charges,85% of total Billed Charges,1094.4,80,,875.52,percent of total Billed Charges,80% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,861.84,63,,689.472,percent of total Billed Charges,63% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,861.84,63,,689.472,percent of total billed charges,63% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,1094.4,80,,875.52,percent of total Billed Charges,80% of Total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,848.16,1162.8,
43248 - Esophagogastroduodenoscopy flexible transoral; with insertion of guide wire followed by pass,50257,CDM,360,RC,43248,HCPCS,Outpatient,,,1368,957.6,,1094.4,80,,875.52,percent of total Billed Charges,80% of Total Billed Charges,861.84,63,,689.472,percent of total Billed charges,63% of Total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total BIlled charges,861.84,63,,689.472,percent of total Billed Charges,63% of total Billed Charges,1162.8,85,,930.24,percent of total Billed Charges,85% of total Billed Charges,1094.4,80,,875.52,percent of total Billed Charges,80% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,861.84,63,,689.472,percent of total Billed Charges,63% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,861.84,63,,689.472,percent of total billed charges,63% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,1094.4,80,,875.52,percent of total Billed Charges,80% of Total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,848.16,62,,678.528,percent of total Billed Charges,62% of total Billed Charges,848.16,1162.8,
43249 - Esophagogastroduodenoscopy flexible transoral; with transendoscopic balloon dilation of esop,50239,CDM,360,RC,43249,HCPCS,Outpatient,,,2670,1869,,2136,80,,1708.8,percent of total Billed Charges,80% of Total Billed Charges,1682.1,63,,1345.68,percent of total Billed charges,63% of Total Billed Charges,1655.4,62,,1324.32,percent of total Billed Charges,62% of total BIlled charges,1682.1,63,,1345.68,percent of total Billed Charges,63% of total Billed Charges,2269.5,85,,1815.6,percent of total Billed Charges,85% of total Billed Charges,2136,80,,1708.8,percent of total Billed Charges,80% of total Billed Charges,1655.4,62,,1324.32,percent of total Billed Charges,62% of total Billed Charges,1682.1,63,,1345.68,percent of total Billed Charges,63% of total Billed Charges,1655.4,62,,1324.32,percent of total Billed Charges,62% of total Billed Charges,1682.1,63,,1345.68,percent of total billed charges,63% of total Billed Charges,1655.4,62,,1324.32,percent of total Billed Charges,62% of total Billed Charges,2136,80,,1708.8,percent of total Billed Charges,80% of Total Billed Charges,1655.4,62,,1324.32,percent of total Billed Charges,62% of total Billed Charges,1655.4,62,,1324.32,percent of total Billed Charges,62% of total Billed Charges,1655.4,2269.5,
43251 - Esophagogastroduodenoscopy flexible transoral; with removal of tumor(s) polyp(s) or other,50261,CDM,360,RC,43251,HCPCS,Outpatient,,,2173,1521.1,,1738.4,80,,1390.72,percent of total Billed Charges,80% of Total Billed Charges,1368.99,63,,1095.192,percent of total Billed charges,63% of Total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total BIlled charges,1368.99,63,,1095.192,percent of total Billed Charges,63% of total Billed Charges,1847.05,85,,1477.64,percent of total Billed Charges,85% of total Billed Charges,1738.4,80,,1390.72,percent of total Billed Charges,80% of total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total Billed Charges,1368.99,63,,1095.192,percent of total Billed Charges,63% of total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total Billed Charges,1368.99,63,,1095.192,percent of total billed charges,63% of total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total Billed Charges,1738.4,80,,1390.72,percent of total Billed Charges,80% of Total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total Billed Charges,1347.26,1847.05,
43255 - Esophagogastroduodenoscopy flexible transoral; with control of bleeding; any method,50260,CDM,360,RC,43255,HCPCS,Outpatient,,,2173,1521.1,,1738.4,80,,1390.72,percent of total Billed Charges,80% of Total Billed Charges,1368.99,63,,1095.192,percent of total Billed charges,63% of Total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total BIlled charges,1368.99,63,,1095.192,percent of total Billed Charges,63% of total Billed Charges,1847.05,85,,1477.64,percent of total Billed Charges,85% of total Billed Charges,1738.4,80,,1390.72,percent of total Billed Charges,80% of total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total Billed Charges,1368.99,63,,1095.192,percent of total Billed Charges,63% of total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total Billed Charges,1368.99,63,,1095.192,percent of total billed charges,63% of total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total Billed Charges,1738.4,80,,1390.72,percent of total Billed Charges,80% of Total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total Billed Charges,1347.26,62,,1077.808,percent of total Billed Charges,62% of total Billed Charges,1347.26,1847.05,
44950 - Appendectomy,544950,CDM,360,RC,44950,HCPCS,Outpatient,,,3747,2622.9,,2997.6,80,,2398.08,percent of total Billed Charges,80% of Total Billed Charges,2360.61,63,,1888.488,percent of total Billed charges,63% of Total Billed Charges,2323.14,62,,1858.512,percent of total Billed Charges,62% of total BIlled charges,2360.61,63,,1888.488,percent of total Billed Charges,63% of total Billed Charges,3184.95,85,,2547.96,percent of total Billed Charges,85% of total Billed Charges,2997.6,80,,2398.08,percent of total Billed Charges,80% of total Billed Charges,2323.14,62,,1858.512,percent of total Billed Charges,62% of total Billed Charges,2360.61,63,,1888.488,percent of total Billed Charges,63% of total Billed Charges,2323.14,62,,1858.512,percent of total Billed Charges,62% of total Billed Charges,2360.61,63,,1888.488,percent of total billed charges,63% of total Billed Charges,2323.14,62,,1858.512,percent of total Billed Charges,62% of total Billed Charges,2997.6,80,,2398.08,percent of total Billed Charges,80% of Total Billed Charges,2323.14,62,,1858.512,percent of total Billed Charges,62% of total Billed Charges,2323.14,62,,1858.512,percent of total Billed Charges,62% of total Billed Charges,2323.14,3184.95,
45171 - Excision of rectal tumor transanal approach; not including muscularis propria (ie partial th,545171,CDM,360,RC,45171,HCPCS,Outpatient,,,4650,3255,,3720,80,,2976,percent of total Billed Charges,80% of Total Billed Charges,2929.5,63,,2343.6,percent of total Billed charges,63% of Total Billed Charges,2883,62,,2306.4,percent of total Billed Charges,62% of total BIlled charges,2929.5,63,,2343.6,percent of total Billed Charges,63% of total Billed Charges,3952.5,85,,3162,percent of total Billed Charges,85% of total Billed Charges,3720,80,,2976,percent of total Billed Charges,80% of total Billed Charges,2883,62,,2306.4,percent of total Billed Charges,62% of total Billed Charges,2929.5,63,,2343.6,percent of total Billed Charges,63% of total Billed Charges,2883,62,,2306.4,percent of total Billed Charges,62% of total Billed Charges,2929.5,63,,2343.6,percent of total billed charges,63% of total Billed Charges,2883,62,,2306.4,percent of total Billed Charges,62% of total Billed Charges,3720,80,,2976,percent of total Billed Charges,80% of Total Billed Charges,2883,62,,2306.4,percent of total Billed Charges,62% of total Billed Charges,2883,62,,2306.4,percent of total Billed Charges,62% of total Billed Charges,2883,3952.5,
Sigmoidoscopy w/wo Collection of specimen(s) by brush/wash,50243,CDM,360,RC,45330,HCPCS,Outpatient,,,941,658.7,,752.8,80,,602.24,percent of total Billed Charges,80% of Total Billed Charges,592.83,63,,474.264,percent of total Billed charges,63% of Total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total BIlled charges,592.83,63,,474.264,percent of total Billed Charges,63% of total Billed Charges,799.85,85,,639.88,percent of total Billed Charges,85% of total Billed Charges,752.8,80,,602.24,percent of total Billed Charges,80% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,592.83,63,,474.264,percent of total Billed Charges,63% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,592.83,63,,474.264,percent of total billed charges,63% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,752.8,80,,602.24,percent of total Billed Charges,80% of Total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,583.42,799.85,
Sigmoidoscopy with Biopsy,50244,CDM,360,RC,45331,HCPCS,Outpatient,,,941,658.7,,752.8,80,,602.24,percent of total Billed Charges,80% of Total Billed Charges,592.83,63,,474.264,percent of total Billed charges,63% of Total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total BIlled charges,592.83,63,,474.264,percent of total Billed Charges,63% of total Billed Charges,799.85,85,,639.88,percent of total Billed Charges,85% of total Billed Charges,752.8,80,,602.24,percent of total Billed Charges,80% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,592.83,63,,474.264,percent of total Billed Charges,63% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,592.83,63,,474.264,percent of total billed charges,63% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,752.8,80,,602.24,percent of total Billed Charges,80% of Total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,583.42,799.85,
"SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S),",50247,CDM,360,RC,45338,HCPCS,Outpatient,,,1590,1113,,1272,80,,1017.6,percent of total Billed Charges,80% of Total Billed Charges,1001.7,63,,801.36,percent of total Billed charges,63% of Total Billed Charges,985.8,62,,788.64,percent of total Billed Charges,62% of total BIlled charges,1001.7,63,,801.36,percent of total Billed Charges,63% of total Billed Charges,1351.5,85,,1081.2,percent of total Billed Charges,85% of total Billed Charges,1272,80,,1017.6,percent of total Billed Charges,80% of total Billed Charges,985.8,62,,788.64,percent of total Billed Charges,62% of total Billed Charges,1001.7,63,,801.36,percent of total Billed Charges,63% of total Billed Charges,985.8,62,,788.64,percent of total Billed Charges,62% of total Billed Charges,1001.7,63,,801.36,percent of total billed charges,63% of total Billed Charges,985.8,62,,788.64,percent of total Billed Charges,62% of total Billed Charges,1272,80,,1017.6,percent of total Billed Charges,80% of Total Billed Charges,985.8,62,,788.64,percent of total Billed Charges,62% of total Billed Charges,985.8,62,,788.64,percent of total Billed Charges,62% of total Billed Charges,985.8,1351.5,
45378 - Colonoscopy flexible; diagnostic including collection of specimen(s) by brushing or washing,50248,CDM,360,RC,45378,HCPCS,Outpatient,,,1503,1052.1,,1202.4,80,,961.92,percent of total Billed Charges,80% of Total Billed Charges,946.89,63,,757.512,percent of total Billed charges,63% of Total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total BIlled charges,946.89,63,,757.512,percent of total Billed Charges,63% of total Billed Charges,1277.55,85,,1022.04,percent of total Billed Charges,85% of total Billed Charges,1202.4,80,,961.92,percent of total Billed Charges,80% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,946.89,63,,757.512,percent of total Billed Charges,63% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,946.89,63,,757.512,percent of total billed charges,63% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,1202.4,80,,961.92,percent of total Billed Charges,80% of Total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,931.86,1277.55,
45379 - Colonoscopy flexible; with removal of foreign body,50249,CDM,360,RC,45379,HCPCS,Outpatient,,,1503,1052.1,,1202.4,80,,961.92,percent of total Billed Charges,80% of Total Billed Charges,946.89,63,,757.512,percent of total Billed charges,63% of Total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total BIlled charges,946.89,63,,757.512,percent of total Billed Charges,63% of total Billed Charges,1277.55,85,,1022.04,percent of total Billed Charges,85% of total Billed Charges,1202.4,80,,961.92,percent of total Billed Charges,80% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,946.89,63,,757.512,percent of total Billed Charges,63% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,946.89,63,,757.512,percent of total billed charges,63% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,1202.4,80,,961.92,percent of total Billed Charges,80% of Total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,931.86,1277.55,
45380 - Colonoscopy flexible; with biopsy,50250,CDM,360,RC,45380,HCPCS,Outpatient,,,1503,1052.1,,1202.4,80,,961.92,percent of total Billed Charges,80% of Total Billed Charges,946.89,63,,757.512,percent of total Billed charges,63% of Total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total BIlled charges,946.89,63,,757.512,percent of total Billed Charges,63% of total Billed Charges,1277.55,85,,1022.04,percent of total Billed Charges,85% of total Billed Charges,1202.4,80,,961.92,percent of total Billed Charges,80% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,946.89,63,,757.512,percent of total Billed Charges,63% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,946.89,63,,757.512,percent of total billed charges,63% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,1202.4,80,,961.92,percent of total Billed Charges,80% of Total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,931.86,1277.55,
45381 - Colonoscopy flexible; with directed submucosal injection any substance,50258,CDM,360,RC,45381,HCPCS,Outpatient,,,1503,1052.1,,1202.4,80,,961.92,percent of total Billed Charges,80% of Total Billed Charges,946.89,63,,757.512,percent of total Billed charges,63% of Total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total BIlled charges,946.89,63,,757.512,percent of total Billed Charges,63% of total Billed Charges,1277.55,85,,1022.04,percent of total Billed Charges,85% of total Billed Charges,1202.4,80,,961.92,percent of total Billed Charges,80% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,946.89,63,,757.512,percent of total Billed Charges,63% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,946.89,63,,757.512,percent of total billed charges,63% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,1202.4,80,,961.92,percent of total Billed Charges,80% of Total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,931.86,1277.55,
45384 - Colonoscopy flexible; with removal of tumor(s) polyp(s) or other lesion(s) by hot biopsy fo,545384,CDM,360,RC,45384,HCPCS,Outpatient,,,1503,1052.1,,1202.4,80,,961.92,percent of total Billed Charges,80% of Total Billed Charges,946.89,63,,757.512,percent of total Billed charges,63% of Total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total BIlled charges,946.89,63,,757.512,percent of total Billed Charges,63% of total Billed Charges,1277.55,85,,1022.04,percent of total Billed Charges,85% of total Billed Charges,1202.4,80,,961.92,percent of total Billed Charges,80% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,946.89,63,,757.512,percent of total Billed Charges,63% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,946.89,63,,757.512,percent of total billed charges,63% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,1202.4,80,,961.92,percent of total Billed Charges,80% of Total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,931.86,1277.55,
45385 - Colonoscopy w/lesion removal,50252,CDM,360,RC,45385,HCPCS,Outpatient,,,1503,1052.1,,1202.4,80,,961.92,percent of total Billed Charges,80% of Total Billed Charges,946.89,63,,757.512,percent of total Billed charges,63% of Total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total BIlled charges,946.89,63,,757.512,percent of total Billed Charges,63% of total Billed Charges,1277.55,85,,1022.04,percent of total Billed Charges,85% of total Billed Charges,1202.4,80,,961.92,percent of total Billed Charges,80% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,946.89,63,,757.512,percent of total Billed Charges,63% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,946.89,63,,757.512,percent of total billed charges,63% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,1202.4,80,,961.92,percent of total Billed Charges,80% of Total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,931.86,62,,745.488,percent of total Billed Charges,62% of total Billed Charges,931.86,1277.55,
45990 - Anorectal exam surgical requiring anesthesia diagnostic,536560,CDM,360,RC,45990,HCPCS,Outpatient,,,7033,4923.1,,5626.4,80,,4501.12,percent of total Billed Charges,80% of Total Billed Charges,4430.79,63,,3544.632,percent of total Billed charges,63% of Total Billed Charges,4360.46,62,,3488.368,percent of total Billed Charges,62% of total BIlled charges,4430.79,63,,3544.632,percent of total Billed Charges,63% of total Billed Charges,5978.05,85,,4782.44,percent of total Billed Charges,85% of total Billed Charges,5626.4,80,,4501.12,percent of total Billed Charges,80% of total Billed Charges,4360.46,62,,3488.368,percent of total Billed Charges,62% of total Billed Charges,4430.79,63,,3544.632,percent of total Billed Charges,63% of total Billed Charges,4360.46,62,,3488.368,percent of total Billed Charges,62% of total Billed Charges,4430.79,63,,3544.632,percent of total billed charges,63% of total Billed Charges,4360.46,62,,3488.368,percent of total Billed Charges,62% of total Billed Charges,5626.4,80,,4501.12,percent of total Billed Charges,80% of Total Billed Charges,4360.46,62,,3488.368,percent of total Billed Charges,62% of total Billed Charges,4360.46,62,,3488.368,percent of total Billed Charges,62% of total Billed Charges,4360.46,5978.05,
46040 - I andD of ischiorectal and/or perirectal abscess,546040,CDM,360,RC,46040,HCPCS,Outpatient,,,2897,2027.9,,2317.6,80,,1854.08,percent of total Billed Charges,80% of Total Billed Charges,1825.11,63,,1460.088,percent of total Billed charges,63% of Total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total BIlled charges,1825.11,63,,1460.088,percent of total Billed Charges,63% of total Billed Charges,2462.45,85,,1969.96,percent of total Billed Charges,85% of total Billed Charges,2317.6,80,,1854.08,percent of total Billed Charges,80% of total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total Billed Charges,1825.11,63,,1460.088,percent of total Billed Charges,63% of total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total Billed Charges,1825.11,63,,1460.088,percent of total billed charges,63% of total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total Billed Charges,2317.6,80,,1854.08,percent of total Billed Charges,80% of Total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total Billed Charges,1796.14,2462.45,
46200 - Fissurectomy including sphincterotomy when performed,546200,CDM,360,RC,46200,HCPCS,Outpatient,,,3895,2726.5,,3116,80,,2492.8,percent of total Billed Charges,80% of Total Billed Charges,2453.85,63,,1963.08,percent of total Billed charges,63% of Total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total BIlled charges,2453.85,63,,1963.08,percent of total Billed Charges,63% of total Billed Charges,3310.75,85,,2648.6,percent of total Billed Charges,85% of total Billed Charges,3116,80,,2492.8,percent of total Billed Charges,80% of total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,2453.85,63,,1963.08,percent of total Billed Charges,63% of total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,2453.85,63,,1963.08,percent of total billed charges,63% of total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,3116,80,,2492.8,percent of total Billed Charges,80% of Total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,2414.9,3310.75,
46221 - Hemorrhoidectomy internal by rubber band ligation,546221,CDM,360,RC,46221,HCPCS,Outpatient,,,965,675.5,,772,80,,617.6,percent of total Billed Charges,80% of Total Billed Charges,607.95,63,,486.36,percent of total Billed charges,63% of Total Billed Charges,598.3,62,,478.64,percent of total Billed Charges,62% of total BIlled charges,607.95,63,,486.36,percent of total Billed Charges,63% of total Billed Charges,820.25,85,,656.2,percent of total Billed Charges,85% of total Billed Charges,772,80,,617.6,percent of total Billed Charges,80% of total Billed Charges,598.3,62,,478.64,percent of total Billed Charges,62% of total Billed Charges,607.95,63,,486.36,percent of total Billed Charges,63% of total Billed Charges,598.3,62,,478.64,percent of total Billed Charges,62% of total Billed Charges,607.95,63,,486.36,percent of total billed charges,63% of total Billed Charges,598.3,62,,478.64,percent of total Billed Charges,62% of total Billed Charges,772,80,,617.6,percent of total Billed Charges,80% of Total Billed Charges,598.3,62,,478.64,percent of total Billed Charges,62% of total Billed Charges,598.3,62,,478.64,percent of total Billed Charges,62% of total Billed Charges,598.3,820.25,
46250 - Hemorrhoidectomy external 2 or more columns/groups,546250,CDM,360,RC,46250,HCPCS,Outpatient,,,3895,2726.5,,3116,80,,2492.8,percent of total Billed Charges,80% of Total Billed Charges,2453.85,63,,1963.08,percent of total Billed charges,63% of Total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total BIlled charges,2453.85,63,,1963.08,percent of total Billed Charges,63% of total Billed Charges,3310.75,85,,2648.6,percent of total Billed Charges,85% of total Billed Charges,3116,80,,2492.8,percent of total Billed Charges,80% of total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,2453.85,63,,1963.08,percent of total Billed Charges,63% of total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,2453.85,63,,1963.08,percent of total billed charges,63% of total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,3116,80,,2492.8,percent of total Billed Charges,80% of Total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,2414.9,3310.75,
46260 - Hemorrhoidectomy internal and external 2 or more columns/groups,546260,CDM,360,RC,46260,HCPCS,Outpatient,,,4335,3034.5,,3468,80,,2774.4,percent of total Billed Charges,80% of Total Billed Charges,2731.05,63,,2184.84,percent of total Billed charges,63% of Total Billed Charges,2687.7,62,,2150.16,percent of total Billed Charges,62% of total BIlled charges,2731.05,63,,2184.84,percent of total Billed Charges,63% of total Billed Charges,3684.75,85,,2947.8,percent of total Billed Charges,85% of total Billed Charges,3468,80,,2774.4,percent of total Billed Charges,80% of total Billed Charges,2687.7,62,,2150.16,percent of total Billed Charges,62% of total Billed Charges,2731.05,63,,2184.84,percent of total Billed Charges,63% of total Billed Charges,2687.7,62,,2150.16,percent of total Billed Charges,62% of total Billed Charges,2731.05,63,,2184.84,percent of total billed charges,63% of total Billed Charges,2687.7,62,,2150.16,percent of total Billed Charges,62% of total Billed Charges,3468,80,,2774.4,percent of total Billed Charges,80% of Total Billed Charges,2687.7,62,,2150.16,percent of total Billed Charges,62% of total Billed Charges,2687.7,62,,2150.16,percent of total Billed Charges,62% of total Billed Charges,2687.7,3684.75,
46270 - Surgical TX of anal fistula ; Subq,546270,CDM,360,RC,46270,HCPCS,Outpatient,,,3895,2726.5,,3116,80,,2492.8,percent of total Billed Charges,80% of Total Billed Charges,2453.85,63,,1963.08,percent of total Billed charges,63% of Total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total BIlled charges,2453.85,63,,1963.08,percent of total Billed Charges,63% of total Billed Charges,3310.75,85,,2648.6,percent of total Billed Charges,85% of total Billed Charges,3116,80,,2492.8,percent of total Billed Charges,80% of total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,2453.85,63,,1963.08,percent of total Billed Charges,63% of total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,2453.85,63,,1963.08,percent of total billed charges,63% of total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,3116,80,,2492.8,percent of total Billed Charges,80% of Total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,2414.9,62,,1931.92,percent of total Billed Charges,62% of total Billed Charges,2414.9,3310.75,
46606 - Anoscopy with biopsy single or multiple,546606,CDM,360,RC,46606,HCPCS,Outpatient,,,1873,1311.1,,1498.4,80,,1198.72,percent of total Billed Charges,80% of Total Billed Charges,1179.99,63,,943.992,percent of total Billed charges,63% of Total Billed Charges,1161.26,62,,929.008,percent of total Billed Charges,62% of total BIlled charges,1179.99,63,,943.992,percent of total Billed Charges,63% of total Billed Charges,1592.05,85,,1273.64,percent of total Billed Charges,85% of total Billed Charges,1498.4,80,,1198.72,percent of total Billed Charges,80% of total Billed Charges,1161.26,62,,929.008,percent of total Billed Charges,62% of total Billed Charges,1179.99,63,,943.992,percent of total Billed Charges,63% of total Billed Charges,1161.26,62,,929.008,percent of total Billed Charges,62% of total Billed Charges,1179.99,63,,943.992,percent of total billed charges,63% of total Billed Charges,1161.26,62,,929.008,percent of total Billed Charges,62% of total Billed Charges,1498.4,80,,1198.72,percent of total Billed Charges,80% of Total Billed Charges,1161.26,62,,929.008,percent of total Billed Charges,62% of total Billed Charges,1161.26,62,,929.008,percent of total Billed Charges,62% of total Billed Charges,1161.26,1592.05,
47562 - Laparoscopy surgical cholecystectomy,547562,CDM,360,RC,47562,HCPCS,Outpatient,,,7443,5210.1,,5954.4,80,,4763.52,percent of total Billed Charges,80% of Total Billed Charges,4689.09,63,,3751.272,percent of total Billed charges,63% of Total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total BIlled charges,4689.09,63,,3751.272,percent of total Billed Charges,63% of total Billed Charges,6326.55,85,,5061.24,percent of total Billed Charges,85% of total Billed Charges,5954.4,80,,4763.52,percent of total Billed Charges,80% of total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total Billed Charges,4689.09,63,,3751.272,percent of total Billed Charges,63% of total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total Billed Charges,4689.09,63,,3751.272,percent of total billed charges,63% of total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total Billed Charges,5954.4,80,,4763.52,percent of total Billed Charges,80% of Total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total Billed Charges,4614.66,6326.55,
47600 - Cholecystectomy,547605,CDM,360,RC,47600,HCPCS,Outpatient,,,3290,2303,,2632,80,,2105.6,percent of total Billed Charges,80% of Total Billed Charges,2072.7,63,,1658.16,percent of total Billed charges,63% of Total Billed Charges,2039.8,62,,1631.84,percent of total Billed Charges,62% of total BIlled charges,2072.7,63,,1658.16,percent of total Billed Charges,63% of total Billed Charges,2796.5,85,,2237.2,percent of total Billed Charges,85% of total Billed Charges,2632,80,,2105.6,percent of total Billed Charges,80% of total Billed Charges,2039.8,62,,1631.84,percent of total Billed Charges,62% of total Billed Charges,2072.7,63,,1658.16,percent of total Billed Charges,63% of total Billed Charges,2039.8,62,,1631.84,percent of total Billed Charges,62% of total Billed Charges,2072.7,63,,1658.16,percent of total billed charges,63% of total Billed Charges,2039.8,62,,1631.84,percent of total Billed Charges,62% of total Billed Charges,2632,80,,2105.6,percent of total Billed Charges,80% of Total Billed Charges,2039.8,62,,1631.84,percent of total Billed Charges,62% of total Billed Charges,2039.8,62,,1631.84,percent of total Billed Charges,62% of total Billed Charges,2039.8,2796.5,
47610 - Cholecystectomy with exploration of common duct,547610,CDM,360,RC,47610,HCPCS,Outpatient,,,3978,2784.6,,3182.4,80,,2545.92,percent of total Billed Charges,80% of Total Billed Charges,2506.14,63,,2004.912,percent of total Billed charges,63% of Total Billed Charges,2466.36,62,,1973.088,percent of total Billed Charges,62% of total BIlled charges,2506.14,63,,2004.912,percent of total Billed Charges,63% of total Billed Charges,3381.3,85,,2705.04,percent of total Billed Charges,85% of total Billed Charges,3182.4,80,,2545.92,percent of total Billed Charges,80% of total Billed Charges,2466.36,62,,1973.088,percent of total Billed Charges,62% of total Billed Charges,2506.14,63,,2004.912,percent of total Billed Charges,63% of total Billed Charges,2466.36,62,,1973.088,percent of total Billed Charges,62% of total Billed Charges,2506.14,63,,2004.912,percent of total billed charges,63% of total Billed Charges,2466.36,62,,1973.088,percent of total Billed Charges,62% of total Billed Charges,3182.4,80,,2545.92,percent of total Billed Charges,80% of Total Billed Charges,2466.36,62,,1973.088,percent of total Billed Charges,62% of total Billed Charges,2466.36,62,,1973.088,percent of total Billed Charges,62% of total Billed Charges,2466.36,3381.3,
49505 - Repair initial inguinal hernia age 5 years or older reducible,549505,CDM,360,RC,49505,HCPCS,Outpatient,,,5304,3712.8,,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3341.52,63,,2673.216,percent of total Billed charges,63% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total BIlled charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,4508.4,85,,3606.72,percent of total Billed Charges,85% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total billed charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,4508.4,
49507 - Repair initial inguinal hernia age 5 years or older incarcerated or strangulated,549507,CDM,360,RC,49507,HCPCS,Outpatient,,,5304,3712.8,,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3341.52,63,,2673.216,percent of total Billed charges,63% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total BIlled charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,4508.4,85,,3606.72,percent of total Billed Charges,85% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total billed charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,4508.4,
49520 - Repair recurrent inguinal hernia any age reducible,549520,CDM,360,RC,49520,HCPCS,Outpatient,,,5304,3712.8,,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3341.52,63,,2673.216,percent of total Billed charges,63% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total BIlled charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,4508.4,85,,3606.72,percent of total Billed Charges,85% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total billed charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,4508.4,
49550 - Repair initial femoral hernia reducible,549550,CDM,360,RC,49550,HCPCS,Outpatient,,,5304,3712.8,,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3341.52,63,,2673.216,percent of total Billed charges,63% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total BIlled charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,4508.4,85,,3606.72,percent of total Billed Charges,85% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total billed charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,4508.4,
49560 - Repair initial incisional or ventral hernia reducible,549560,CDM,360,RC,49560,HCPCS,Outpatient,,,5304,3712.8,,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3341.52,63,,2673.216,percent of total Billed charges,63% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total BIlled charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,4508.4,85,,3606.72,percent of total Billed Charges,85% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total billed charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,4508.4,
49561 - Repair initial incisional or ventral hernia incarcerated or strangulated;,549561,CDM,360,RC,49561,HCPCS,Outpatient,,,2958,2070.6,,2366.4,80,,1893.12,percent of total Billed Charges,80% of Total Billed Charges,1863.54,63,,1490.832,percent of total Billed charges,63% of Total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total BIlled charges,1863.54,63,,1490.832,percent of total Billed Charges,63% of total Billed Charges,2514.3,85,,2011.44,percent of total Billed Charges,85% of total Billed Charges,2366.4,80,,1893.12,percent of total Billed Charges,80% of total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total Billed Charges,1863.54,63,,1490.832,percent of total Billed Charges,63% of total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total Billed Charges,1863.54,63,,1490.832,percent of total billed charges,63% of total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total Billed Charges,2366.4,80,,1893.12,percent of total Billed Charges,80% of Total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total Billed Charges,1833.96,2514.3,
49570 - Repair epigastric hernia reducible,549570,CDM,360,RC,49570,HCPCS,Outpatient,,,5304,3712.8,,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3341.52,63,,2673.216,percent of total Billed charges,63% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total BIlled charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,4508.4,85,,3606.72,percent of total Billed Charges,85% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total billed charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,4508.4,
49585 - Repair umbilical hernia age 5 years or older reducible,549585,CDM,360,RC,49585,HCPCS,Outpatient,,,5304,3712.8,,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3341.52,63,,2673.216,percent of total Billed charges,63% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total BIlled charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,4508.4,85,,3606.72,percent of total Billed Charges,85% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total billed charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,4508.4,
49587 - Repair umbilical hernia age 5 years or older incarcerated or strangulated,549587,CDM,360,RC,49587,HCPCS,Outpatient,,,5304,3712.8,,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3341.52,63,,2673.216,percent of total Billed charges,63% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total BIlled charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,4508.4,85,,3606.72,percent of total Billed Charges,85% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total billed charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,4508.4,
49650 - Laparoscopy surgical repair initial inguinal hernia,549650,CDM,360,RC,49650,HCPCS,Outpatient,,,7443,5210.1,,5954.4,80,,4763.52,percent of total Billed Charges,80% of Total Billed Charges,4689.09,63,,3751.272,percent of total Billed charges,63% of Total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total BIlled charges,4689.09,63,,3751.272,percent of total Billed Charges,63% of total Billed Charges,6326.55,85,,5061.24,percent of total Billed Charges,85% of total Billed Charges,5954.4,80,,4763.52,percent of total Billed Charges,80% of total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total Billed Charges,4689.09,63,,3751.272,percent of total Billed Charges,63% of total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total Billed Charges,4689.09,63,,3751.272,percent of total billed charges,63% of total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total Billed Charges,5954.4,80,,4763.52,percent of total Billed Charges,80% of Total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total Billed Charges,4614.66,62,,3691.728,percent of total Billed Charges,62% of total Billed Charges,4614.66,6326.55,
51050 - Cystolithotomy cystotomy with removal of calculus without vesical neck resection;,551050,CDM,360,RC,51050,HCPCS,Outpatient,,,4095,2866.5,,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2579.85,63,,2063.88,percent of total Billed charges,63% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total BIlled charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,3480.75,85,,2784.6,percent of total Billed Charges,85% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total billed charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,3480.75,
51102 - Aspiration of bladder; with insertion of suprapubic catheter;,551010,CDM,360,RC,51102,HCPCS,Outpatient,,,2896,2027.2,,2316.8,80,,1853.44,percent of total Billed Charges,80% of Total Billed Charges,1824.48,63,,1459.584,percent of total Billed charges,63% of Total Billed Charges,1795.52,62,,1436.416,percent of total Billed Charges,62% of total BIlled charges,1824.48,63,,1459.584,percent of total Billed Charges,63% of total Billed Charges,2461.6,85,,1969.28,percent of total Billed Charges,85% of total Billed Charges,2316.8,80,,1853.44,percent of total Billed Charges,80% of total Billed Charges,1795.52,62,,1436.416,percent of total Billed Charges,62% of total Billed Charges,1824.48,63,,1459.584,percent of total Billed Charges,63% of total Billed Charges,1795.52,62,,1436.416,percent of total Billed Charges,62% of total Billed Charges,1824.48,63,,1459.584,percent of total billed charges,63% of total Billed Charges,1795.52,62,,1436.416,percent of total Billed Charges,62% of total Billed Charges,2316.8,80,,1853.44,percent of total Billed Charges,80% of Total Billed Charges,1795.52,62,,1436.416,percent of total Billed Charges,62% of total Billed Charges,1795.52,62,,1436.416,percent of total Billed Charges,62% of total Billed Charges,1795.52,2461.6,
52000 - Cystourethroscopy (separate procedure);,552000,CDM,360,RC,52000,HCPCS,Outpatient,,,1101,770.7,,880.8,80,,704.64,percent of total Billed Charges,80% of Total Billed Charges,693.63,63,,554.904,percent of total Billed charges,63% of Total Billed Charges,682.62,62,,546.096,percent of total Billed Charges,62% of total BIlled charges,693.63,63,,554.904,percent of total Billed Charges,63% of total Billed Charges,935.85,85,,748.68,percent of total Billed Charges,85% of total Billed Charges,880.8,80,,704.64,percent of total Billed Charges,80% of total Billed Charges,682.62,62,,546.096,percent of total Billed Charges,62% of total Billed Charges,693.63,63,,554.904,percent of total Billed Charges,63% of total Billed Charges,682.62,62,,546.096,percent of total Billed Charges,62% of total Billed Charges,693.63,63,,554.904,percent of total billed charges,63% of total Billed Charges,682.62,62,,546.096,percent of total Billed Charges,62% of total Billed Charges,880.8,80,,704.64,percent of total Billed Charges,80% of Total Billed Charges,682.62,62,,546.096,percent of total Billed Charges,62% of total Billed Charges,682.62,62,,546.096,percent of total Billed Charges,62% of total Billed Charges,682.62,935.85,
52204 - Cystourethroscopy with biopsy(s);,552204,CDM,360,RC,52204,HCPCS,Outpatient,,,4095,2866.5,,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2579.85,63,,2063.88,percent of total Billed charges,63% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total BIlled charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,3480.75,85,,2784.6,percent of total Billed Charges,85% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total billed charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,3480.75,
52224 - CYSTOURETHROSCOPY WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OR TREATM,552224,CDM,360,RC,52224,HCPCS,Outpatient,,,4095,2866.5,,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2579.85,63,,2063.88,percent of total Billed charges,63% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total BIlled charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,3480.75,85,,2784.6,percent of total Billed Charges,85% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total billed charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,3480.75,
52234 - Cystourethroscopy with fulguration and/or resection of SMALL bladder tumor(s) (0.5 up to 2.0 c,552234,CDM,360,RC,52234,HCPCS,Outpatient,,,4095,2866.5,,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2579.85,63,,2063.88,percent of total Billed charges,63% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total BIlled charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,3480.75,85,,2784.6,percent of total Billed Charges,85% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total billed charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,3480.75,
52260 - Cystourethroscopy w/ dilation of bladder; general or conduction anesthesia;,552260,CDM,360,RC,52260,HCPCS,Outpatient,,,2458,1720.6,,1966.4,80,,1573.12,percent of total Billed Charges,80% of Total Billed Charges,1548.54,63,,1238.832,percent of total Billed charges,63% of Total Billed Charges,1523.96,62,,1219.168,percent of total Billed Charges,62% of total BIlled charges,1548.54,63,,1238.832,percent of total Billed Charges,63% of total Billed Charges,2089.3,85,,1671.44,percent of total Billed Charges,85% of total Billed Charges,1966.4,80,,1573.12,percent of total Billed Charges,80% of total Billed Charges,1523.96,62,,1219.168,percent of total Billed Charges,62% of total Billed Charges,1548.54,63,,1238.832,percent of total Billed Charges,63% of total Billed Charges,1523.96,62,,1219.168,percent of total Billed Charges,62% of total Billed Charges,1548.54,63,,1238.832,percent of total billed charges,63% of total Billed Charges,1523.96,62,,1219.168,percent of total Billed Charges,62% of total Billed Charges,1966.4,80,,1573.12,percent of total Billed Charges,80% of Total Billed Charges,1523.96,62,,1219.168,percent of total Billed Charges,62% of total Billed Charges,1523.96,62,,1219.168,percent of total Billed Charges,62% of total Billed Charges,1523.96,2089.3,
52265 - CYSTOURETHROSCOPY WITH DILATION OF BLADDER FOR INTERSTITIAL CYSTITIS; LOCAL ANESTHESIA,552265,CDM,360,RC,52265,HCPCS,Outpatient,,,1101,770.7,,880.8,80,,704.64,percent of total Billed Charges,80% of Total Billed Charges,693.63,63,,554.904,percent of total Billed charges,63% of Total Billed Charges,682.62,62,,546.096,percent of total Billed Charges,62% of total BIlled charges,693.63,63,,554.904,percent of total Billed Charges,63% of total Billed Charges,935.85,85,,748.68,percent of total Billed Charges,85% of total Billed Charges,880.8,80,,704.64,percent of total Billed Charges,80% of total Billed Charges,682.62,62,,546.096,percent of total Billed Charges,62% of total Billed Charges,693.63,63,,554.904,percent of total Billed Charges,63% of total Billed Charges,682.62,62,,546.096,percent of total Billed Charges,62% of total Billed Charges,693.63,63,,554.904,percent of total billed charges,63% of total Billed Charges,682.62,62,,546.096,percent of total Billed Charges,62% of total Billed Charges,880.8,80,,704.64,percent of total Billed Charges,80% of Total Billed Charges,682.62,62,,546.096,percent of total Billed Charges,62% of total Billed Charges,682.62,62,,546.096,percent of total Billed Charges,62% of total Billed Charges,682.62,935.85,
52281 - Cystourethroscopy w/ calib/dilation w/wo meatotomy w/wo injection procedure Male/Female;,552281,CDM,360,RC,52281,HCPCS,Outpatient,,,2458,1720.6,,1966.4,80,,1573.12,percent of total Billed Charges,80% of Total Billed Charges,1548.54,63,,1238.832,percent of total Billed charges,63% of Total Billed Charges,1523.96,62,,1219.168,percent of total Billed Charges,62% of total BIlled charges,1548.54,63,,1238.832,percent of total Billed Charges,63% of total Billed Charges,2089.3,85,,1671.44,percent of total Billed Charges,85% of total Billed Charges,1966.4,80,,1573.12,percent of total Billed Charges,80% of total Billed Charges,1523.96,62,,1219.168,percent of total Billed Charges,62% of total Billed Charges,1548.54,63,,1238.832,percent of total Billed Charges,63% of total Billed Charges,1523.96,62,,1219.168,percent of total Billed Charges,62% of total Billed Charges,1548.54,63,,1238.832,percent of total billed charges,63% of total Billed Charges,1523.96,62,,1219.168,percent of total Billed Charges,62% of total Billed Charges,1966.4,80,,1573.12,percent of total Billed Charges,80% of Total Billed Charges,1523.96,62,,1219.168,percent of total Billed Charges,62% of total Billed Charges,1523.96,62,,1219.168,percent of total Billed Charges,62% of total Billed Charges,1523.96,2089.3,
52310 - Cystourethroscopy w/ removal of foreign body calculus or ureteral stent; simple;,552310,CDM,360,RC,52310,HCPCS,Outpatient,,,3480,2436,,2784,80,,2227.2,percent of total Billed Charges,80% of Total Billed Charges,2192.4,63,,1753.92,percent of total Billed charges,63% of Total Billed Charges,2157.6,62,,1726.08,percent of total Billed Charges,62% of total BIlled charges,2192.4,63,,1753.92,percent of total Billed Charges,63% of total Billed Charges,2958,85,,2366.4,percent of total Billed Charges,85% of total Billed Charges,2784,80,,2227.2,percent of total Billed Charges,80% of total Billed Charges,2157.6,62,,1726.08,percent of total Billed Charges,62% of total Billed Charges,2192.4,63,,1753.92,percent of total Billed Charges,63% of total Billed Charges,2157.6,62,,1726.08,percent of total Billed Charges,62% of total Billed Charges,2192.4,63,,1753.92,percent of total billed charges,63% of total Billed Charges,2157.6,62,,1726.08,percent of total Billed Charges,62% of total Billed Charges,2784,80,,2227.2,percent of total Billed Charges,80% of Total Billed Charges,2157.6,62,,1726.08,percent of total Billed Charges,62% of total Billed Charges,2157.6,62,,1726.08,percent of total Billed Charges,62% of total Billed Charges,2157.6,2958,
52332 - Cystourethroscopy with insertion of indwelling ureteral stent (eg Gibbons or double-J type);,552332,CDM,360,RC,52332,HCPCS,Outpatient,,,4095,2866.5,,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2579.85,63,,2063.88,percent of total Billed charges,63% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total BIlled charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,3480.75,85,,2784.6,percent of total Billed Charges,85% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total billed charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,3480.75,
52351 - Cystourethroscopy with ureteroscopy and/or pyeloscopy; diagnostic;,552351,CDM,360,RC,52351,HCPCS,Outpatient,,,4095,2866.5,,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2579.85,63,,2063.88,percent of total Billed charges,63% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total BIlled charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,3480.75,85,,2784.6,percent of total Billed Charges,85% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total Billed Charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2579.85,63,,2063.88,percent of total billed charges,63% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,3276,80,,2620.8,percent of total Billed Charges,80% of Total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,62,,2031.12,percent of total Billed Charges,62% of total Billed Charges,2538.9,3480.75,
53600 - Dilation of urethral stricture by passage of sound or urethral dilator male; initial;,536563,CDM,360,RC,53600,HCPCS,Outpatient,,,470,329,,376,80,,300.8,percent of total Billed Charges,80% of Total Billed Charges,296.1,63,,236.88,percent of total Billed charges,63% of Total Billed Charges,291.4,62,,233.12,percent of total Billed Charges,62% of total BIlled charges,296.1,63,,236.88,percent of total Billed Charges,63% of total Billed Charges,399.5,85,,319.6,percent of total Billed Charges,85% of total Billed Charges,376,80,,300.8,percent of total Billed Charges,80% of total Billed Charges,291.4,62,,233.12,percent of total Billed Charges,62% of total Billed Charges,296.1,63,,236.88,percent of total Billed Charges,63% of total Billed Charges,291.4,62,,233.12,percent of total Billed Charges,62% of total Billed Charges,296.1,63,,236.88,percent of total billed charges,63% of total Billed Charges,291.4,62,,233.12,percent of total Billed Charges,62% of total Billed Charges,376,80,,300.8,percent of total Billed Charges,80% of Total Billed Charges,291.4,62,,233.12,percent of total Billed Charges,62% of total Billed Charges,291.4,62,,233.12,percent of total Billed Charges,62% of total Billed Charges,291.4,399.5,
53660 - Dilation of female urethra including suppository and/or instillation; initial;,536576,CDM,360,RC,53660,HCPCS,Outpatient,,,286,200.2,,228.8,80,,183.04,percent of total Billed Charges,80% of Total Billed Charges,180.18,63,,144.144,percent of total Billed charges,63% of Total Billed Charges,177.32,62,,141.856,percent of total Billed Charges,62% of total BIlled charges,180.18,63,,144.144,percent of total Billed Charges,63% of total Billed Charges,243.1,85,,194.48,percent of total Billed Charges,85% of total Billed Charges,228.8,80,,183.04,percent of total Billed Charges,80% of total Billed Charges,177.32,62,,141.856,percent of total Billed Charges,62% of total Billed Charges,180.18,63,,144.144,percent of total Billed Charges,63% of total Billed Charges,177.32,62,,141.856,percent of total Billed Charges,62% of total Billed Charges,180.18,63,,144.144,percent of total billed charges,63% of total Billed Charges,177.32,62,,141.856,percent of total Billed Charges,62% of total Billed Charges,228.8,80,,183.04,percent of total Billed Charges,80% of Total Billed Charges,177.32,62,,141.856,percent of total Billed Charges,62% of total Billed Charges,177.32,62,,141.856,percent of total Billed Charges,62% of total Billed Charges,177.32,243.1,
54161 - Circumcision surgical excision other than clamp device or dorsal slit older than 28 days of,554161,CDM,360,RC,54161,HCPCS,Outpatient,,,638,446.6,,510.4,80,,408.32,percent of total Billed Charges,80% of Total Billed Charges,401.94,63,,321.552,percent of total Billed charges,63% of Total Billed Charges,395.56,62,,316.448,percent of total Billed Charges,62% of total BIlled charges,401.94,63,,321.552,percent of total Billed Charges,63% of total Billed Charges,542.3,85,,433.84,percent of total Billed Charges,85% of total Billed Charges,510.4,80,,408.32,percent of total Billed Charges,80% of total Billed Charges,395.56,62,,316.448,percent of total Billed Charges,62% of total Billed Charges,401.94,63,,321.552,percent of total Billed Charges,63% of total Billed Charges,395.56,62,,316.448,percent of total Billed Charges,62% of total Billed Charges,401.94,63,,321.552,percent of total billed charges,63% of total Billed Charges,395.56,62,,316.448,percent of total Billed Charges,62% of total Billed Charges,510.4,80,,408.32,percent of total Billed Charges,80% of Total Billed Charges,395.56,62,,316.448,percent of total Billed Charges,62% of total Billed Charges,395.56,62,,316.448,percent of total Billed Charges,62% of total Billed Charges,395.56,542.3,
54520-Excision procedure on the testis,554520,CDM,360,RC,54520,HCPCS,Outpatient,,,6411,4487.7,,5128.8,80,,4103.04,percent of total Billed Charges,80% of Total Billed Charges,4038.93,63,,3231.144,percent of total Billed charges,63% of Total Billed Charges,3974.82,62,,3179.856,percent of total Billed Charges,62% of total BIlled charges,4038.93,63,,3231.144,percent of total Billed Charges,63% of total Billed Charges,5449.35,85,,4359.48,percent of total Billed Charges,85% of total Billed Charges,5128.8,80,,4103.04,percent of total Billed Charges,80% of total Billed Charges,3974.82,62,,3179.856,percent of total Billed Charges,62% of total Billed Charges,4038.93,63,,3231.144,percent of total Billed Charges,63% of total Billed Charges,3974.82,62,,3179.856,percent of total Billed Charges,62% of total Billed Charges,4038.93,63,,3231.144,percent of total billed charges,63% of total Billed Charges,3974.82,62,,3179.856,percent of total Billed Charges,62% of total Billed Charges,5128.8,80,,4103.04,percent of total Billed Charges,80% of Total Billed Charges,3974.82,62,,3179.856,percent of total Billed Charges,62% of total Billed Charges,3974.82,62,,3179.856,percent of total Billed Charges,62% of total Billed Charges,3974.82,5449.35,
54700 - SHAVING EPIDERMAL/DERMAL LESION SINGL LESION S/N/H/F/G 0.5CM OR LESS,554700,CDM,360,RC,54700,HCPCS,Outpatient,,,3540,2478,,2832,80,,2265.6,percent of total Billed Charges,80% of Total Billed Charges,2230.2,63,,1784.16,percent of total Billed charges,63% of Total Billed Charges,2194.8,62,,1755.84,percent of total Billed Charges,62% of total BIlled charges,2230.2,63,,1784.16,percent of total Billed Charges,63% of total Billed Charges,3009,85,,2407.2,percent of total Billed Charges,85% of total Billed Charges,2832,80,,2265.6,percent of total Billed Charges,80% of total Billed Charges,2194.8,62,,1755.84,percent of total Billed Charges,62% of total Billed Charges,2230.2,63,,1784.16,percent of total Billed Charges,63% of total Billed Charges,2194.8,62,,1755.84,percent of total Billed Charges,62% of total Billed Charges,2230.2,63,,1784.16,percent of total billed charges,63% of total Billed Charges,2194.8,62,,1755.84,percent of total Billed Charges,62% of total Billed Charges,2832,80,,2265.6,percent of total Billed Charges,80% of Total Billed Charges,2194.8,62,,1755.84,percent of total Billed Charges,62% of total Billed Charges,2194.8,62,,1755.84,percent of total Billed Charges,62% of total Billed Charges,2194.8,3009,
55040 - Excision of hydrocele unilateral,555040,CDM,360,RC,55040,HCPCS,Outpatient,,,5304,3712.8,,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3341.52,63,,2673.216,percent of total Billed charges,63% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total BIlled charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,4508.4,85,,3606.72,percent of total Billed Charges,85% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total billed charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,4508.4,
55041 - Excision of hydrocele bilateral,555041,CDM,360,RC,55041,HCPCS,Outpatient,,,5304,3712.8,,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3341.52,63,,2673.216,percent of total Billed charges,63% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total BIlled charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,4508.4,85,,3606.72,percent of total Billed Charges,85% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total billed charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,4508.4,
55500 - Excision of hydrocele of spermatic cord unilateral,555500,CDM,360,RC,55500,HCPCS,Outpatient,,,4438,3106.6,,3550.4,80,,2840.32,percent of total Billed Charges,80% of Total Billed Charges,2795.94,63,,2236.752,percent of total Billed charges,63% of Total Billed Charges,2751.56,62,,2201.248,percent of total Billed Charges,62% of total BIlled charges,2795.94,63,,2236.752,percent of total Billed Charges,63% of total Billed Charges,3772.3,85,,3017.84,percent of total Billed Charges,85% of total Billed Charges,3550.4,80,,2840.32,percent of total Billed Charges,80% of total Billed Charges,2751.56,62,,2201.248,percent of total Billed Charges,62% of total Billed Charges,2795.94,63,,2236.752,percent of total Billed Charges,63% of total Billed Charges,2751.56,62,,2201.248,percent of total Billed Charges,62% of total Billed Charges,2795.94,63,,2236.752,percent of total billed charges,63% of total Billed Charges,2751.56,62,,2201.248,percent of total Billed Charges,62% of total Billed Charges,3550.4,80,,2840.32,percent of total Billed Charges,80% of Total Billed Charges,2751.56,62,,2201.248,percent of total Billed Charges,62% of total Billed Charges,2751.56,62,,2201.248,percent of total Billed Charges,62% of total Billed Charges,2751.56,3772.3,
55540 - SML INTEST ENDOSCOPY/ENTEREOSCOPY BEYOND 2ND PORTION DUODENUM W/BX,555540,CDM,360,RC,55540,HCPCS,Outpatient,,,5304,3712.8,,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3341.52,63,,2673.216,percent of total Billed charges,63% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total BIlled charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,4508.4,85,,3606.72,percent of total Billed Charges,85% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total Billed Charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3341.52,63,,2673.216,percent of total billed charges,63% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,4243.2,80,,3394.56,percent of total Billed Charges,80% of Total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,62,,2630.784,percent of total Billed Charges,62% of total Billed Charges,3288.48,4508.4,
55700 - Biopsy prostate; needle or punch single or multiple any approach;,555700,CDM,360,RC,55700,HCPCS,Outpatient,,,2166,1516.2,,1732.8,80,,1386.24,percent of total Billed Charges,80% of Total Billed Charges,1364.58,63,,1091.664,percent of total Billed charges,63% of Total Billed Charges,1342.92,62,,1074.336,percent of total Billed Charges,62% of total BIlled charges,1364.58,63,,1091.664,percent of total Billed Charges,63% of total Billed Charges,1841.1,85,,1472.88,percent of total Billed Charges,85% of total Billed Charges,1732.8,80,,1386.24,percent of total Billed Charges,80% of total Billed Charges,1342.92,62,,1074.336,percent of total Billed Charges,62% of total Billed Charges,1364.58,63,,1091.664,percent of total Billed Charges,63% of total Billed Charges,1342.92,62,,1074.336,percent of total Billed Charges,62% of total Billed Charges,1364.58,63,,1091.664,percent of total billed charges,63% of total Billed Charges,1342.92,62,,1074.336,percent of total Billed Charges,62% of total Billed Charges,1732.8,80,,1386.24,percent of total Billed Charges,80% of Total Billed Charges,1342.92,62,,1074.336,percent of total Billed Charges,62% of total Billed Charges,1342.92,62,,1074.336,percent of total Billed Charges,62% of total Billed Charges,1342.92,1841.1,
55706 - BIOPSIES PROSTATE NEEDLE TRANSPERINEAL STEREOTACTIC TEMPLATE GUIDED SATURATION SAM;,555706,CDM,360,RC,55706,HCPCS,Outpatient,,,2166,1516.2,,1732.8,80,,1386.24,percent of total Billed Charges,80% of Total Billed Charges,1364.58,63,,1091.664,percent of total Billed charges,63% of Total Billed Charges,1342.92,62,,1074.336,percent of total Billed Charges,62% of total BIlled charges,1364.58,63,,1091.664,percent of total Billed Charges,63% of total Billed Charges,1841.1,85,,1472.88,percent of total Billed Charges,85% of total Billed Charges,1732.8,80,,1386.24,percent of total Billed Charges,80% of total Billed Charges,1342.92,62,,1074.336,percent of total Billed Charges,62% of total Billed Charges,1364.58,63,,1091.664,percent of total Billed Charges,63% of total Billed Charges,1342.92,62,,1074.336,percent of total Billed Charges,62% of total Billed Charges,1364.58,63,,1091.664,percent of total billed charges,63% of total Billed Charges,1342.92,62,,1074.336,percent of total Billed Charges,62% of total Billed Charges,1732.8,80,,1386.24,percent of total Billed Charges,80% of Total Billed Charges,1342.92,62,,1074.336,percent of total Billed Charges,62% of total Billed Charges,1342.92,62,,1074.336,percent of total Billed Charges,62% of total Billed Charges,1342.92,1841.1,
56405 - I andD of vulva or perineal abscess,556405,CDM,360,RC,56405,HCPCS,Outpatient,,,387,270.9,,309.6,80,,247.68,percent of total Billed Charges,80% of Total Billed Charges,243.81,63,,195.048,percent of total Billed charges,63% of Total Billed Charges,239.94,62,,191.952,percent of total Billed Charges,62% of total BIlled charges,243.81,63,,195.048,percent of total Billed Charges,63% of total Billed Charges,328.95,85,,263.16,percent of total Billed Charges,85% of total Billed Charges,309.6,80,,247.68,percent of total Billed Charges,80% of total Billed Charges,239.94,62,,191.952,percent of total Billed Charges,62% of total Billed Charges,243.81,63,,195.048,percent of total Billed Charges,63% of total Billed Charges,239.94,62,,191.952,percent of total Billed Charges,62% of total Billed Charges,243.81,63,,195.048,percent of total billed charges,63% of total Billed Charges,239.94,62,,191.952,percent of total Billed Charges,62% of total Billed Charges,309.6,80,,247.68,percent of total Billed Charges,80% of Total Billed Charges,239.94,62,,191.952,percent of total Billed Charges,62% of total Billed Charges,239.94,62,,191.952,percent of total Billed Charges,62% of total Billed Charges,239.94,328.95,
56442 - SUTURE SML INTESTINE F/PERFORATED ULCER/DIVERTICULUM/WOUND SNGL,556720,CDM,360,RC,56442,HCPCS,Outpatient,,,2806,1964.2,,2244.8,80,,1795.84,percent of total Billed Charges,80% of Total Billed Charges,1767.78,63,,1414.224,percent of total Billed charges,63% of Total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total BIlled charges,1767.78,63,,1414.224,percent of total Billed Charges,63% of total Billed Charges,2385.1,85,,1908.08,percent of total Billed Charges,85% of total Billed Charges,2244.8,80,,1795.84,percent of total Billed Charges,80% of total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,1767.78,63,,1414.224,percent of total Billed Charges,63% of total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,1767.78,63,,1414.224,percent of total billed charges,63% of total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,2244.8,80,,1795.84,percent of total Billed Charges,80% of Total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,1739.72,2385.1,
56740 - TENOLYSIS FLEX/EXT TENDON FOREARM/WRIST SNGL EACH TENDON,556740,CDM,360,RC,56740,HCPCS,Outpatient,,,5147,3602.9,,4117.6,80,,3294.08,percent of total Billed Charges,80% of Total Billed Charges,3242.61,63,,2594.088,percent of total Billed charges,63% of Total Billed Charges,3191.14,62,,2552.912,percent of total Billed Charges,62% of total BIlled charges,3242.61,63,,2594.088,percent of total Billed Charges,63% of total Billed Charges,4374.95,85,,3499.96,percent of total Billed Charges,85% of total Billed Charges,4117.6,80,,3294.08,percent of total Billed Charges,80% of total Billed Charges,3191.14,62,,2552.912,percent of total Billed Charges,62% of total Billed Charges,3242.61,63,,2594.088,percent of total Billed Charges,63% of total Billed Charges,3191.14,62,,2552.912,percent of total Billed Charges,62% of total Billed Charges,3242.61,63,,2594.088,percent of total billed charges,63% of total Billed Charges,3191.14,62,,2552.912,percent of total Billed Charges,62% of total Billed Charges,4117.6,80,,3294.08,percent of total Billed Charges,80% of Total Billed Charges,3191.14,62,,2552.912,percent of total Billed Charges,62% of total Billed Charges,3191.14,62,,2552.912,percent of total Billed Charges,62% of total Billed Charges,3191.14,4374.95,
66982 - Extracapsular cataract removal w/insertion intraocular prosthesis1-stage procedurecomplex;,566982,CDM,360,RC,66982,HCPCS,Outpatient,,,3850,2695,,3080,80,,2464,percent of total Billed Charges,80% of Total Billed Charges,2425.5,63,,1940.4,percent of total Billed charges,63% of Total Billed Charges,2387,62,,1909.6,percent of total Billed Charges,62% of total BIlled charges,2425.5,63,,1940.4,percent of total Billed Charges,63% of total Billed Charges,3272.5,85,,2618,percent of total Billed Charges,85% of total Billed Charges,3080,80,,2464,percent of total Billed Charges,80% of total Billed Charges,2387,62,,1909.6,percent of total Billed Charges,62% of total Billed Charges,2425.5,63,,1940.4,percent of total Billed Charges,63% of total Billed Charges,2387,62,,1909.6,percent of total Billed Charges,62% of total Billed Charges,2425.5,63,,1940.4,percent of total billed charges,63% of total Billed Charges,2387,62,,1909.6,percent of total Billed Charges,62% of total Billed Charges,3080,80,,2464,percent of total Billed Charges,80% of Total Billed Charges,2387,62,,1909.6,percent of total Billed Charges,62% of total Billed Charges,2387,62,,1909.6,percent of total Billed Charges,62% of total Billed Charges,2387,3272.5,
67800 - Excision of chalazion; single;,567800,CDM,360,RC,67800,HCPCS,Outpatient,,,521,364.7,,416.8,80,,333.44,percent of total Billed Charges,80% of Total Billed Charges,328.23,63,,262.584,percent of total Billed charges,63% of Total Billed Charges,323.02,62,,258.416,percent of total Billed Charges,62% of total BIlled charges,328.23,63,,262.584,percent of total Billed Charges,63% of total Billed Charges,442.85,85,,354.28,percent of total Billed Charges,85% of total Billed Charges,416.8,80,,333.44,percent of total Billed Charges,80% of total Billed Charges,323.02,62,,258.416,percent of total Billed Charges,62% of total Billed Charges,328.23,63,,262.584,percent of total Billed Charges,63% of total Billed Charges,323.02,62,,258.416,percent of total Billed Charges,62% of total Billed Charges,328.23,63,,262.584,percent of total billed charges,63% of total Billed Charges,323.02,62,,258.416,percent of total Billed Charges,62% of total Billed Charges,416.8,80,,333.44,percent of total Billed Charges,80% of Total Billed Charges,323.02,62,,258.416,percent of total Billed Charges,62% of total Billed Charges,323.02,62,,258.416,percent of total Billed Charges,62% of total Billed Charges,323.02,442.85,
67808 - Excision chalazion; under general anesthesia and/or requiring hospitalization single-multipl,567808,CDM,360,RC,67808,HCPCS,Outpatient,,,2958,2070.6,,2366.4,80,,1893.12,percent of total Billed Charges,80% of Total Billed Charges,1863.54,63,,1490.832,percent of total Billed charges,63% of Total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total BIlled charges,1863.54,63,,1490.832,percent of total Billed Charges,63% of total Billed Charges,2514.3,85,,2011.44,percent of total Billed Charges,85% of total Billed Charges,2366.4,80,,1893.12,percent of total Billed Charges,80% of total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total Billed Charges,1863.54,63,,1490.832,percent of total Billed Charges,63% of total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total Billed Charges,1863.54,63,,1490.832,percent of total billed charges,63% of total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total Billed Charges,2366.4,80,,1893.12,percent of total Billed Charges,80% of Total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total Billed Charges,1833.96,62,,1467.168,percent of total Billed Charges,62% of total Billed Charges,1833.96,2514.3,
67810 - Incisional biopsy of eyelid skin including lid margin;,567810,CDM,360,RC,67810,HCPCS,Outpatient,,,521,364.7,,416.8,80,,333.44,percent of total Billed Charges,80% of Total Billed Charges,328.23,63,,262.584,percent of total Billed charges,63% of Total Billed Charges,323.02,62,,258.416,percent of total Billed Charges,62% of total BIlled charges,328.23,63,,262.584,percent of total Billed Charges,63% of total Billed Charges,442.85,85,,354.28,percent of total Billed Charges,85% of total Billed Charges,416.8,80,,333.44,percent of total Billed Charges,80% of total Billed Charges,323.02,62,,258.416,percent of total Billed Charges,62% of total Billed Charges,328.23,63,,262.584,percent of total Billed Charges,63% of total Billed Charges,323.02,62,,258.416,percent of total Billed Charges,62% of total Billed Charges,328.23,63,,262.584,percent of total billed charges,63% of total Billed Charges,323.02,62,,258.416,percent of total Billed Charges,62% of total Billed Charges,416.8,80,,333.44,percent of total Billed Charges,80% of Total Billed Charges,323.02,62,,258.416,percent of total Billed Charges,62% of total Billed Charges,323.02,62,,258.416,percent of total Billed Charges,62% of total Billed Charges,323.02,442.85,
67840 - Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure;,567840,CDM,360,RC,67840,HCPCS,Outpatient,,,510,357,,408,80,,326.4,percent of total Billed Charges,80% of Total Billed Charges,321.3,63,,257.04,percent of total Billed charges,63% of Total Billed Charges,316.2,62,,252.96,percent of total Billed Charges,62% of total BIlled charges,321.3,63,,257.04,percent of total Billed Charges,63% of total Billed Charges,433.5,85,,346.8,percent of total Billed Charges,85% of total Billed Charges,408,80,,326.4,percent of total Billed Charges,80% of total Billed Charges,316.2,62,,252.96,percent of total Billed Charges,62% of total Billed Charges,321.3,63,,257.04,percent of total Billed Charges,63% of total Billed Charges,316.2,62,,252.96,percent of total Billed Charges,62% of total Billed Charges,321.3,63,,257.04,percent of total billed charges,63% of total Billed Charges,316.2,62,,252.96,percent of total Billed Charges,62% of total Billed Charges,408,80,,326.4,percent of total Billed Charges,80% of Total Billed Charges,316.2,62,,252.96,percent of total Billed Charges,62% of total Billed Charges,316.2,62,,252.96,percent of total Billed Charges,62% of total Billed Charges,316.2,433.5,
68510 - BIOPSY LACRIMAL GLND,568510,CDM,360,RC,68510,HCPCS,Outpatient,,,3131,2191.7,,2504.8,80,,2003.84,percent of total Billed Charges,80% of Total Billed Charges,1972.53,63,,1578.024,percent of total Billed charges,63% of Total Billed Charges,1941.22,62,,1552.976,percent of total Billed Charges,62% of total BIlled charges,1972.53,63,,1578.024,percent of total Billed Charges,63% of total Billed Charges,2661.35,85,,2129.08,percent of total Billed Charges,85% of total Billed Charges,2504.8,80,,2003.84,percent of total Billed Charges,80% of total Billed Charges,1941.22,62,,1552.976,percent of total Billed Charges,62% of total Billed Charges,1972.53,63,,1578.024,percent of total Billed Charges,63% of total Billed Charges,1941.22,62,,1552.976,percent of total Billed Charges,62% of total Billed Charges,1972.53,63,,1578.024,percent of total billed charges,63% of total Billed Charges,1941.22,62,,1552.976,percent of total Billed Charges,62% of total Billed Charges,2504.8,80,,2003.84,percent of total Billed Charges,80% of Total Billed Charges,1941.22,62,,1552.976,percent of total Billed Charges,62% of total Billed Charges,1941.22,62,,1552.976,percent of total Billed Charges,62% of total Billed Charges,1941.22,2661.35,
69005 - Drainage external ear abscess or hematoma; complicated;,569005,CDM,360,RC,69005,HCPCS,Outpatient,,,1724,1206.8,,1379.2,80,,1103.36,percent of total Billed Charges,80% of Total Billed Charges,1086.12,63,,868.896,percent of total Billed charges,63% of Total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total BIlled charges,1086.12,63,,868.896,percent of total Billed Charges,63% of total Billed Charges,1465.4,85,,1172.32,percent of total Billed Charges,85% of total Billed Charges,1379.2,80,,1103.36,percent of total Billed Charges,80% of total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1086.12,63,,868.896,percent of total Billed Charges,63% of total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1086.12,63,,868.896,percent of total billed charges,63% of total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1379.2,80,,1103.36,percent of total Billed Charges,80% of Total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1068.88,1465.4,
69100 - Biopsy external ear;,569100,CDM,360,RC,69100,HCPCS,Outpatient,,,534,373.8,,427.2,80,,341.76,percent of total Billed Charges,80% of Total Billed Charges,336.42,63,,269.136,percent of total Billed charges,63% of Total Billed Charges,331.08,62,,264.864,percent of total Billed Charges,62% of total BIlled charges,336.42,63,,269.136,percent of total Billed Charges,63% of total Billed Charges,453.9,85,,363.12,percent of total Billed Charges,85% of total Billed Charges,427.2,80,,341.76,percent of total Billed Charges,80% of total Billed Charges,331.08,62,,264.864,percent of total Billed Charges,62% of total Billed Charges,336.42,63,,269.136,percent of total Billed Charges,63% of total Billed Charges,331.08,62,,264.864,percent of total Billed Charges,62% of total Billed Charges,336.42,63,,269.136,percent of total billed charges,63% of total Billed Charges,331.08,62,,264.864,percent of total Billed Charges,62% of total Billed Charges,427.2,80,,341.76,percent of total Billed Charges,80% of Total Billed Charges,331.08,62,,264.864,percent of total Billed Charges,62% of total Billed Charges,331.08,62,,264.864,percent of total Billed Charges,62% of total Billed Charges,331.08,453.9,
Sigmoidoscopy Flexible,50256,CDM,360,RC,,,Outpatient,,,941,658.7,,752.8,80,,602.24,percent of total Billed Charges,80% of Total Billed Charges,592.83,63,,474.264,percent of total Billed charges,63% of Total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total BIlled charges,592.83,63,,474.264,percent of total Billed Charges,63% of total Billed Charges,799.85,85,,639.88,percent of total Billed Charges,85% of total Billed Charges,752.8,80,,602.24,percent of total Billed Charges,80% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,592.83,63,,474.264,percent of total Billed Charges,63% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,592.83,63,,474.264,percent of total billed charges,63% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,752.8,80,,602.24,percent of total Billed Charges,80% of Total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,583.42,799.85,
G0105 - COLONOSCOPY MEDICARE SCREENING HIGH RISK PATIENT,50253,CDM,360,RC,,,Outpatient,,,1320,924,,1056,80,,844.8,percent of total Billed Charges,80% of Total Billed Charges,831.6,63,,665.28,percent of total Billed charges,63% of Total Billed Charges,818.4,62,,654.72,percent of total Billed Charges,62% of total BIlled charges,831.6,63,,665.28,percent of total Billed Charges,63% of total Billed Charges,1122,85,,897.6,percent of total Billed Charges,85% of total Billed Charges,1056,80,,844.8,percent of total Billed Charges,80% of total Billed Charges,818.4,62,,654.72,percent of total Billed Charges,62% of total Billed Charges,831.6,63,,665.28,percent of total Billed Charges,63% of total Billed Charges,818.4,62,,654.72,percent of total Billed Charges,62% of total Billed Charges,831.6,63,,665.28,percent of total billed charges,63% of total Billed Charges,818.4,62,,654.72,percent of total Billed Charges,62% of total Billed Charges,1056,80,,844.8,percent of total Billed Charges,80% of Total Billed Charges,818.4,62,,654.72,percent of total Billed Charges,62% of total Billed Charges,818.4,62,,654.72,percent of total Billed Charges,62% of total Billed Charges,818.4,1122,
G0121 - COLONOSCOPY SCREENING,50254,CDM,360,RC,,,Outpatient,,,1320,924,,1056,80,,844.8,percent of total Billed Charges,80% of Total Billed Charges,831.6,63,,665.28,percent of total Billed charges,63% of Total Billed Charges,818.4,62,,654.72,percent of total Billed Charges,62% of total BIlled charges,831.6,63,,665.28,percent of total Billed Charges,63% of total Billed Charges,1122,85,,897.6,percent of total Billed Charges,85% of total Billed Charges,1056,80,,844.8,percent of total Billed Charges,80% of total Billed Charges,818.4,62,,654.72,percent of total Billed Charges,62% of total Billed Charges,831.6,63,,665.28,percent of total Billed Charges,63% of total Billed Charges,818.4,62,,654.72,percent of total Billed Charges,62% of total Billed Charges,831.6,63,,665.28,percent of total billed charges,63% of total Billed Charges,818.4,62,,654.72,percent of total Billed Charges,62% of total Billed Charges,1056,80,,844.8,percent of total Billed Charges,80% of Total Billed Charges,818.4,62,,654.72,percent of total Billed Charges,62% of total Billed Charges,818.4,62,,654.72,percent of total Billed Charges,62% of total Billed Charges,818.4,1122,
Sigmoidoscopy Flexible-WLMH,50256,CDM,360,RC,,,Outpatient,,,941,658.7,,752.8,80,,602.24,percent of total Billed Charges,80% of Total Billed Charges,592.83,63,,474.264,percent of total Billed charges,63% of Total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total BIlled charges,592.83,63,,474.264,percent of total Billed Charges,63% of total Billed Charges,799.85,85,,639.88,percent of total Billed Charges,85% of total Billed Charges,752.8,80,,602.24,percent of total Billed Charges,80% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,592.83,63,,474.264,percent of total Billed Charges,63% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,592.83,63,,474.264,percent of total billed charges,63% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,752.8,80,,602.24,percent of total Billed Charges,80% of Total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,583.42,799.85,
Sigmoidoscopy w/wo Collection of specimen(s) by brushing of,50243,CDM,360,RC,45330,HCPCS,Outpatient,,,941,658.7,,752.8,80,,602.24,percent of total Billed Charges,80% of Total Billed Charges,592.83,63,,474.264,percent of total Billed charges,63% of Total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total BIlled charges,592.83,63,,474.264,percent of total Billed Charges,63% of total Billed Charges,799.85,85,,639.88,percent of total Billed Charges,85% of total Billed Charges,752.8,80,,602.24,percent of total Billed Charges,80% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,592.83,63,,474.264,percent of total Billed Charges,63% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,592.83,63,,474.264,percent of total billed charges,63% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,752.8,80,,602.24,percent of total Billed Charges,80% of Total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,583.42,799.85,
Sigmoidoscopy with Biopsy,50244,CDM,360,RC,45331,HCPCS,Outpatient,,,941,658.7,,752.8,80,,602.24,percent of total Billed Charges,80% of Total Billed Charges,592.83,63,,474.264,percent of total Billed charges,63% of Total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total BIlled charges,592.83,63,,474.264,percent of total Billed Charges,63% of total Billed Charges,799.85,85,,639.88,percent of total Billed Charges,85% of total Billed Charges,752.8,80,,602.24,percent of total Billed Charges,80% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,592.83,63,,474.264,percent of total Billed Charges,63% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,592.83,63,,474.264,percent of total billed charges,63% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,752.8,80,,602.24,percent of total Billed Charges,80% of Total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,583.42,62,,466.736,percent of total Billed Charges,62% of total Billed Charges,583.42,799.85,
10060 Incision  and Drainage Abscess (Simple),700001,CDM,361,RC,10060,HCPCS,Outpatient,,,382,267.4,,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,240.66,63,,192.528,percent of total Billed charges,63% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total BIlled charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,324.7,85,,259.76,percent of total Billed Charges,85% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total billed charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,324.7,
10061 Incision  and Drainage Complicated/Multiple Charge,10061,CDM,361,RC,700002,HCPCS,Outpatient,,,760,532,,608,80,,486.4,percent of total Billed Charges,80% of Total Billed Charges,478.8,63,,383.04,percent of total Billed charges,63% of Total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total BIlled charges,478.8,63,,383.04,percent of total Billed Charges,63% of total Billed Charges,646,85,,516.8,percent of total Billed Charges,85% of total Billed Charges,608,80,,486.4,percent of total Billed Charges,80% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,478.8,63,,383.04,percent of total Billed Charges,63% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,478.8,63,,383.04,percent of total billed charges,63% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,608,80,,486.4,percent of total Billed Charges,80% of Total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,471.2,646,
10120 Incision  and removal of Foreign Body Simple Charge,700004,CDM,361,RC,10120,HCPCS,Outpatient,,,760,532,,608,80,,486.4,percent of total Billed Charges,80% of Total Billed Charges,478.8,63,,383.04,percent of total Billed charges,63% of Total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total BIlled charges,478.8,63,,383.04,percent of total Billed Charges,63% of total Billed Charges,646,85,,516.8,percent of total Billed Charges,85% of total Billed Charges,608,80,,486.4,percent of total Billed Charges,80% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,478.8,63,,383.04,percent of total Billed Charges,63% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,478.8,63,,383.04,percent of total billed charges,63% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,608,80,,486.4,percent of total Billed Charges,80% of Total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,471.2,646,
"10140 I andD hematoma, seroma, or fluid collection Charge",700005,CDM,361,RC,10140,HCPCS,Outpatient,,,3090,2163,,2472,80,,1977.6,percent of total Billed Charges,80% of Total Billed Charges,1946.7,63,,1557.36,percent of total Billed charges,63% of Total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total BIlled charges,1946.7,63,,1557.36,percent of total Billed Charges,63% of total Billed Charges,2626.5,85,,2101.2,percent of total Billed Charges,85% of total Billed Charges,2472,80,,1977.6,percent of total Billed Charges,80% of total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total Billed Charges,1946.7,63,,1557.36,percent of total Billed Charges,63% of total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total Billed Charges,1946.7,63,,1557.36,percent of total billed charges,63% of total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total Billed Charges,2472,80,,1977.6,percent of total Billed Charges,80% of Total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total Billed Charges,1915.8,2626.5,
10160 Puncture Aspiration of Abscess Charge,700006,CDM,361,RC,10160,HCPCS,Outpatient,,,760,532,,608,80,,486.4,percent of total Billed Charges,80% of Total Billed Charges,478.8,63,,383.04,percent of total Billed charges,63% of Total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total BIlled charges,478.8,63,,383.04,percent of total Billed Charges,63% of total Billed Charges,646,85,,516.8,percent of total Billed Charges,85% of total Billed Charges,608,80,,486.4,percent of total Billed Charges,80% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,478.8,63,,383.04,percent of total Billed Charges,63% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,478.8,63,,383.04,percent of total billed charges,63% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,608,80,,486.4,percent of total Billed Charges,80% of Total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,471.2,646,
10180 I andD Post op Infection Charge,700007,CDM,361,RC,10180,HCPCS,Outpatient,,,5415,3790.5,,4332,80,,3465.6,percent of total Billed Charges,80% of Total Billed Charges,3411.45,63,,2729.16,percent of total Billed charges,63% of Total Billed Charges,3357.3,62,,2685.84,percent of total Billed Charges,62% of total BIlled charges,3411.45,63,,2729.16,percent of total Billed Charges,63% of total Billed Charges,4602.75,85,,3682.2,percent of total Billed Charges,85% of total Billed Charges,4332,80,,3465.6,percent of total Billed Charges,80% of total Billed Charges,3357.3,62,,2685.84,percent of total Billed Charges,62% of total Billed Charges,3411.45,63,,2729.16,percent of total Billed Charges,63% of total Billed Charges,3357.3,62,,2685.84,percent of total Billed Charges,62% of total Billed Charges,3411.45,63,,2729.16,percent of total billed charges,63% of total Billed Charges,3357.3,62,,2685.84,percent of total Billed Charges,62% of total Billed Charges,4332,80,,3465.6,percent of total Billed Charges,80% of Total Billed Charges,3357.3,62,,2685.84,percent of total Billed Charges,62% of total Billed Charges,3357.3,62,,2685.84,percent of total Billed Charges,62% of total Billed Charges,3357.3,4602.75,
"11042 Debride, subq tissue - 1st 20 sq. cm Charge",700008,CDM,361,RC,11042,HCPCS,Outpatient,,,760,532,,608,80,,486.4,percent of total Billed Charges,80% of Total Billed Charges,478.8,63,,383.04,percent of total Billed charges,63% of Total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total BIlled charges,478.8,63,,383.04,percent of total Billed Charges,63% of total Billed Charges,646,85,,516.8,percent of total Billed Charges,85% of total Billed Charges,608,80,,486.4,percent of total Billed Charges,80% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,478.8,63,,383.04,percent of total Billed Charges,63% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,478.8,63,,383.04,percent of total billed charges,63% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,608,80,,486.4,percent of total Billed Charges,80% of Total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,471.2,646,
"11043 Debride, muscle/fascia - 1st 20 sq. cm Charge",700009,CDM,361,RC,11043,HCPCS,Outpatient,,,1197,837.9,,957.6,80,,766.08,percent of total Billed Charges,80% of Total Billed Charges,754.11,63,,603.288,percent of total Billed charges,63% of Total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total BIlled charges,754.11,63,,603.288,percent of total Billed Charges,63% of total Billed Charges,1017.45,85,,813.96,percent of total Billed Charges,85% of total Billed Charges,957.6,80,,766.08,percent of total Billed Charges,80% of total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total Billed Charges,754.11,63,,603.288,percent of total Billed Charges,63% of total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total Billed Charges,754.11,63,,603.288,percent of total billed charges,63% of total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total Billed Charges,957.6,80,,766.08,percent of total Billed Charges,80% of Total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total Billed Charges,742.14,1017.45,
"11044 Debride, bone - 1st 20 sq. cm Charge",700010,CDM,361,RC,11044,HCPCS,Outpatient,,,3090,2163,,2472,80,,1977.6,percent of total Billed Charges,80% of Total Billed Charges,1946.7,63,,1557.36,percent of total Billed charges,63% of Total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total BIlled charges,1946.7,63,,1557.36,percent of total Billed Charges,63% of total Billed Charges,2626.5,85,,2101.2,percent of total Billed Charges,85% of total Billed Charges,2472,80,,1977.6,percent of total Billed Charges,80% of total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total Billed Charges,1946.7,63,,1557.36,percent of total Billed Charges,63% of total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total Billed Charges,1946.7,63,,1557.36,percent of total billed charges,63% of total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total Billed Charges,2472,80,,1977.6,percent of total Billed Charges,80% of Total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total Billed Charges,1915.8,2626.5,
11055 Trim Skin Lesion Charge,700014,CDM,361,RC,11055,HCPCS,Outpatient,,,382,267.4,,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,240.66,63,,192.528,percent of total Billed charges,63% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total BIlled charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,324.7,85,,259.76,percent of total Billed Charges,85% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total billed charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,324.7,
11056 Trim 2-4 Lesions Charge,700015,CDM,361,RC,11056,HCPCS,Outpatient,,,382,267.4,,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,240.66,63,,192.528,percent of total Billed charges,63% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total BIlled charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,324.7,85,,259.76,percent of total Billed Charges,85% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total billed charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,324.7,
11057 Trim > 4 Lesions Charge,700016,CDM,361,RC,11057,HCPCS,Outpatient,,,382,267.4,,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,240.66,63,,192.528,percent of total Billed charges,63% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total BIlled charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,324.7,85,,259.76,percent of total Billed Charges,85% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total billed charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,324.7,
"11102 Tangential Biopsy of Skin, 1 lesion Charge",700017,CDM,361,RC,11102,HCPCS,Outpatient,,,382,267.4,,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,240.66,63,,192.528,percent of total Billed charges,63% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total BIlled charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,324.7,85,,259.76,percent of total Billed Charges,85% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total billed charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,324.7,
"11103 Tangential Biopsy of Skin, each additional lesion Char",700018,CDM,361,RC,11103,HCPCS,Outpatient,,,382,267.4,,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,240.66,63,,192.528,percent of total Billed charges,63% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total BIlled charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,324.7,85,,259.76,percent of total Billed Charges,85% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total billed charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,324.7,
11104 Punch Biopsy of Skin 1 Lesion Charge,700019,CDM,361,RC,11104,HCPCS,Outpatient,,,760,532,,608,80,,486.4,percent of total Billed Charges,80% of Total Billed Charges,478.8,63,,383.04,percent of total Billed charges,63% of Total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total BIlled charges,478.8,63,,383.04,percent of total Billed Charges,63% of total Billed Charges,646,85,,516.8,percent of total Billed Charges,85% of total Billed Charges,608,80,,486.4,percent of total Billed Charges,80% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,478.8,63,,383.04,percent of total Billed Charges,63% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,478.8,63,,383.04,percent of total billed charges,63% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,608,80,,486.4,percent of total Billed Charges,80% of Total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,471.2,646,
"11105 Punch Biospy of Skin, each additional lesion Charge",700020,CDM,361,RC,11105,HCPCS,Outpatient,,,760,532,,608,80,,486.4,percent of total Billed Charges,80% of Total Billed Charges,478.8,63,,383.04,percent of total Billed charges,63% of Total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total BIlled charges,478.8,63,,383.04,percent of total Billed Charges,63% of total Billed Charges,646,85,,516.8,percent of total Billed Charges,85% of total Billed Charges,608,80,,486.4,percent of total Billed Charges,80% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,478.8,63,,383.04,percent of total Billed Charges,63% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,478.8,63,,383.04,percent of total billed charges,63% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,608,80,,486.4,percent of total Billed Charges,80% of Total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,471.2,646,
"11106 Incisional Biopsy of Skin, 1 lesion Charge",700021,CDM,361,RC,11106,HCPCS,Outpatient,,,1197,837.9,,957.6,80,,766.08,percent of total Billed Charges,80% of Total Billed Charges,754.11,63,,603.288,percent of total Billed charges,63% of Total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total BIlled charges,754.11,63,,603.288,percent of total Billed Charges,63% of total Billed Charges,1017.45,85,,813.96,percent of total Billed Charges,85% of total Billed Charges,957.6,80,,766.08,percent of total Billed Charges,80% of total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total Billed Charges,754.11,63,,603.288,percent of total Billed Charges,63% of total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total Billed Charges,754.11,63,,603.288,percent of total billed charges,63% of total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total Billed Charges,957.6,80,,766.08,percent of total Billed Charges,80% of Total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total Billed Charges,742.14,1017.45,
"11107 Incisional Biopsy of Skin, Each additional lesion Char",700022,CDM,361,RC,11107,HCPCS,Outpatient,,,1197,837.9,,957.6,80,,766.08,percent of total Billed Charges,80% of Total Billed Charges,754.11,63,,603.288,percent of total Billed charges,63% of Total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total BIlled charges,754.11,63,,603.288,percent of total Billed Charges,63% of total Billed Charges,1017.45,85,,813.96,percent of total Billed Charges,85% of total Billed Charges,957.6,80,,766.08,percent of total Billed Charges,80% of total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total Billed Charges,754.11,63,,603.288,percent of total Billed Charges,63% of total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total Billed Charges,754.11,63,,603.288,percent of total billed charges,63% of total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total Billed Charges,957.6,80,,766.08,percent of total Billed Charges,80% of Total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total Billed Charges,742.14,1017.45,
11719 Trimming of Nondystrophic Nails Charge,700023,CDM,361,RC,11719,HCPCS,Outpatient,,,117,81.9,,93.6,80,,74.88,percent of total Billed Charges,80% of Total Billed Charges,73.71,63,,58.968,percent of total Billed charges,63% of Total Billed Charges,72.54,62,,58.032,percent of total Billed Charges,62% of total BIlled charges,73.71,63,,58.968,percent of total Billed Charges,63% of total Billed Charges,99.45,85,,79.56,percent of total Billed Charges,85% of total Billed Charges,93.6,80,,74.88,percent of total Billed Charges,80% of total Billed Charges,72.54,62,,58.032,percent of total Billed Charges,62% of total Billed Charges,73.71,63,,58.968,percent of total Billed Charges,63% of total Billed Charges,72.54,62,,58.032,percent of total Billed Charges,62% of total Billed Charges,73.71,63,,58.968,percent of total billed charges,63% of total Billed Charges,72.54,62,,58.032,percent of total Billed Charges,62% of total Billed Charges,93.6,80,,74.88,percent of total Billed Charges,80% of Total Billed Charges,72.54,62,,58.032,percent of total Billed Charges,62% of total Billed Charges,72.54,62,,58.032,percent of total Billed Charges,62% of total Billed Charges,72.54,99.45,
11721 Debride Nails >5 Charge,700026,CDM,361,RC,11721,HCPCS,Outpatient,,,117,81.9,,93.6,80,,74.88,percent of total Billed Charges,80% of Total Billed Charges,73.71,63,,58.968,percent of total Billed charges,63% of Total Billed Charges,72.54,62,,58.032,percent of total Billed Charges,62% of total BIlled charges,73.71,63,,58.968,percent of total Billed Charges,63% of total Billed Charges,99.45,85,,79.56,percent of total Billed Charges,85% of total Billed Charges,93.6,80,,74.88,percent of total Billed Charges,80% of total Billed Charges,72.54,62,,58.032,percent of total Billed Charges,62% of total Billed Charges,73.71,63,,58.968,percent of total Billed Charges,63% of total Billed Charges,72.54,62,,58.032,percent of total Billed Charges,62% of total Billed Charges,73.71,63,,58.968,percent of total billed charges,63% of total Billed Charges,72.54,62,,58.032,percent of total Billed Charges,62% of total Billed Charges,93.6,80,,74.88,percent of total Billed Charges,80% of Total Billed Charges,72.54,62,,58.032,percent of total Billed Charges,62% of total Billed Charges,72.54,62,,58.032,percent of total Billed Charges,62% of total Billed Charges,72.54,99.45,
11730 Remove Nail Plate Charge,700027,CDM,361,RC,11730,HCPCS,Outpatient,,,382,267.4,,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,240.66,63,,192.528,percent of total Billed charges,63% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total BIlled charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,324.7,85,,259.76,percent of total Billed Charges,85% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total billed charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,324.7,
"11732 Remove Nail Plate, Additional Charge",700028,CDM,361,RC,11732,HCPCS,Outpatient,,,382,267.4,,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,240.66,63,,192.528,percent of total Billed charges,63% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total BIlled charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,324.7,85,,259.76,percent of total Billed Charges,85% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total billed charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,324.7,
11750 Permanent Nail Removal Charge,700030,CDM,361,RC,11750,HCPCS,Outpatient,,,760,532,,608,80,,486.4,percent of total Billed Charges,80% of Total Billed Charges,478.8,63,,383.04,percent of total Billed charges,63% of Total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total BIlled charges,478.8,63,,383.04,percent of total Billed Charges,63% of total Billed Charges,646,85,,516.8,percent of total Billed Charges,85% of total Billed Charges,608,80,,486.4,percent of total Billed Charges,80% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,478.8,63,,383.04,percent of total Billed Charges,63% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,478.8,63,,383.04,percent of total billed charges,63% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,608,80,,486.4,percent of total Billed Charges,80% of Total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,471.2,646,
"15002 Surgical prep-trunk/arm/leg, 1st 100 sq cm Charge",700034,CDM,361,RC,15002,HCPCS,Outpatient,,,3476,2433.2,,2780.8,80,,2224.64,percent of total Billed Charges,80% of Total Billed Charges,2189.88,63,,1751.904,percent of total Billed charges,63% of Total Billed Charges,2155.12,62,,1724.096,percent of total Billed Charges,62% of total BIlled charges,2189.88,63,,1751.904,percent of total Billed Charges,63% of total Billed Charges,2954.6,85,,2363.68,percent of total Billed Charges,85% of total Billed Charges,2780.8,80,,2224.64,percent of total Billed Charges,80% of total Billed Charges,2155.12,62,,1724.096,percent of total Billed Charges,62% of total Billed Charges,2189.88,63,,1751.904,percent of total Billed Charges,63% of total Billed Charges,2155.12,62,,1724.096,percent of total Billed Charges,62% of total Billed Charges,2189.88,63,,1751.904,percent of total billed charges,63% of total Billed Charges,2155.12,62,,1724.096,percent of total Billed Charges,62% of total Billed Charges,2780.8,80,,2224.64,percent of total Billed Charges,80% of Total Billed Charges,2155.12,62,,1724.096,percent of total Billed Charges,62% of total Billed Charges,2155.12,62,,1724.096,percent of total Billed Charges,62% of total Billed Charges,2155.12,2954.6,
15004 Surgical prep-face/hands/feet 1st 100 sq cm Charge,700035,CDM,361,RC,15004,HCPCS,Outpatient,,,1197,837.9,,957.6,80,,766.08,percent of total Billed Charges,80% of Total Billed Charges,754.11,63,,603.288,percent of total Billed charges,63% of Total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total BIlled charges,754.11,63,,603.288,percent of total Billed Charges,63% of total Billed Charges,1017.45,85,,813.96,percent of total Billed Charges,85% of total Billed Charges,957.6,80,,766.08,percent of total Billed Charges,80% of total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total Billed Charges,754.11,63,,603.288,percent of total Billed Charges,63% of total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total Billed Charges,754.11,63,,603.288,percent of total billed charges,63% of total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total Billed Charges,957.6,80,,766.08,percent of total Billed Charges,80% of Total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total Billed Charges,742.14,62,,593.712,percent of total Billed Charges,62% of total Billed Charges,742.14,1017.45,
"16000 Initial treatment, 1st degree burn(s) Charge",700040,CDM,361,RC,16000,HCPCS,Outpatient,,,382,267.4,,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,240.66,63,,192.528,percent of total Billed charges,63% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total BIlled charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,324.7,85,,259.76,percent of total Billed Charges,85% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total billed charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,324.7,
"16025 Dsg and/or debride PT burns, int/sub medium (5-10%BSA)",700042,CDM,361,RC,16025,HCPCS,Outpatient,,,382,267.4,,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,240.66,63,,192.528,percent of total Billed charges,63% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total BIlled charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,324.7,85,,259.76,percent of total Billed Charges,85% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total billed charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,324.7,
"16030 Dsg and/or debride PT burns, int/sub large (>10%BSA) C",700043,CDM,361,RC,16030,HCPCS,Outpatient,,,760,532,,608,80,,486.4,percent of total Billed Charges,80% of Total Billed Charges,478.8,63,,383.04,percent of total Billed charges,63% of Total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total BIlled charges,478.8,63,,383.04,percent of total Billed Charges,63% of total Billed Charges,646,85,,516.8,percent of total Billed Charges,85% of total Billed Charges,608,80,,486.4,percent of total Billed Charges,80% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,478.8,63,,383.04,percent of total Billed Charges,63% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,478.8,63,,383.04,percent of total billed charges,63% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,608,80,,486.4,percent of total Billed Charges,80% of Total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,471.2,62,,376.96,percent of total Billed Charges,62% of total Billed Charges,471.2,646,
17250 Chemical Cauterization of Granulation Tissue,700044,CDM,361,RC,17250,HCPCS,Outpatient,,,382,267.4,,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,240.66,63,,192.528,percent of total Billed charges,63% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total BIlled charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,324.7,85,,259.76,percent of total Billed Charges,85% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total Billed Charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,240.66,63,,192.528,percent of total billed charges,63% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,305.6,80,,244.48,percent of total Billed Charges,80% of Total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,62,,189.472,percent of total Billed Charges,62% of total Billed Charges,236.84,324.7,
"20220 Biopsy of Bone - superficial, needle Charge",700045,CDM,361,RC,20220,HCPCS,Outpatient,,,3090,2163,,2472,80,,1977.6,percent of total Billed Charges,80% of Total Billed Charges,1946.7,63,,1557.36,percent of total Billed charges,63% of Total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total BIlled charges,1946.7,63,,1557.36,percent of total Billed Charges,63% of total Billed Charges,2626.5,85,,2101.2,percent of total Billed Charges,85% of total Billed Charges,2472,80,,1977.6,percent of total Billed Charges,80% of total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total Billed Charges,1946.7,63,,1557.36,percent of total Billed Charges,63% of total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total Billed Charges,1946.7,63,,1557.36,percent of total billed charges,63% of total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total Billed Charges,2472,80,,1977.6,percent of total Billed Charges,80% of Total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total Billed Charges,1915.8,2626.5,
"20225 Biopsy of Bone - deep, needle Charge",700046,CDM,361,RC,20225,HCPCS,Outpatient,,,3090,2163,,2472,80,,1977.6,percent of total Billed Charges,80% of Total Billed Charges,1946.7,63,,1557.36,percent of total Billed charges,63% of Total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total BIlled charges,1946.7,63,,1557.36,percent of total Billed Charges,63% of total Billed Charges,2626.5,85,,2101.2,percent of total Billed Charges,85% of total Billed Charges,2472,80,,1977.6,percent of total Billed Charges,80% of total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total Billed Charges,1946.7,63,,1557.36,percent of total Billed Charges,63% of total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total Billed Charges,1946.7,63,,1557.36,percent of total billed charges,63% of total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total Billed Charges,2472,80,,1977.6,percent of total Billed Charges,80% of Total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total Billed Charges,1915.8,62,,1532.64,percent of total Billed Charges,62% of total Billed Charges,1915.8,2626.5,
20600 Aspiration/Injection of Small Joint/Bursa Charge,700047,CDM,361,RC,20600,HCPCS,Outpatient,,,565,395.5,,452,80,,361.6,percent of total Billed Charges,80% of Total Billed Charges,355.95,63,,284.76,percent of total Billed charges,63% of Total Billed Charges,350.3,62,,280.24,percent of total Billed Charges,62% of total BIlled charges,355.95,63,,284.76,percent of total Billed Charges,63% of total Billed Charges,480.25,85,,384.2,percent of total Billed Charges,85% of total Billed Charges,452,80,,361.6,percent of total Billed Charges,80% of total Billed Charges,350.3,62,,280.24,percent of total Billed Charges,62% of total Billed Charges,355.95,63,,284.76,percent of total Billed Charges,63% of total Billed Charges,350.3,62,,280.24,percent of total Billed Charges,62% of total Billed Charges,355.95,63,,284.76,percent of total billed charges,63% of total Billed Charges,350.3,62,,280.24,percent of total Billed Charges,62% of total Billed Charges,452,80,,361.6,percent of total Billed Charges,80% of Total Billed Charges,350.3,62,,280.24,percent of total Billed Charges,62% of total Billed Charges,350.3,62,,280.24,percent of total Billed Charges,62% of total Billed Charges,350.3,480.25,
29445 Total Contact Cast Charge,700052,CDM,361,RC,29445,HCPCS,Outpatient,,,512,358.4,,409.6,80,,327.68,percent of total Billed Charges,80% of Total Billed Charges,322.56,63,,258.048,percent of total Billed charges,63% of Total Billed Charges,317.44,62,,253.952,percent of total Billed Charges,62% of total BIlled charges,322.56,63,,258.048,percent of total Billed Charges,63% of total Billed Charges,435.2,85,,348.16,percent of total Billed Charges,85% of total Billed Charges,409.6,80,,327.68,percent of total Billed Charges,80% of total Billed Charges,317.44,62,,253.952,percent of total Billed Charges,62% of total Billed Charges,322.56,63,,258.048,percent of total Billed Charges,63% of total Billed Charges,317.44,62,,253.952,percent of total Billed Charges,62% of total Billed Charges,322.56,63,,258.048,percent of total billed charges,63% of total Billed Charges,317.44,62,,253.952,percent of total Billed Charges,62% of total Billed Charges,409.6,80,,327.68,percent of total Billed Charges,80% of Total Billed Charges,317.44,62,,253.952,percent of total Billed Charges,62% of total Billed Charges,317.44,62,,253.952,percent of total Billed Charges,62% of total Billed Charges,317.44,435.2,
29515 Application of Short Leg Cast Charge,700053,CDM,361,RC,29515,HCPCS,Outpatient,,,301,210.7,,240.8,80,,192.64,percent of total Billed Charges,80% of Total Billed Charges,189.63,63,,151.704,percent of total Billed charges,63% of Total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total BIlled charges,189.63,63,,151.704,percent of total Billed Charges,63% of total Billed Charges,255.85,85,,204.68,percent of total Billed Charges,85% of total Billed Charges,240.8,80,,192.64,percent of total Billed Charges,80% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,189.63,63,,151.704,percent of total Billed Charges,63% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,189.63,63,,151.704,percent of total billed charges,63% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,240.8,80,,192.64,percent of total Billed Charges,80% of Total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,186.62,255.85,
29580 Application of unna boot Charge,700054,CDM,361,RC,29580,HCPCS,Outpatient,,,301,210.7,,240.8,80,,192.64,percent of total Billed Charges,80% of Total Billed Charges,189.63,63,,151.704,percent of total Billed charges,63% of Total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total BIlled charges,189.63,63,,151.704,percent of total Billed Charges,63% of total Billed Charges,255.85,85,,204.68,percent of total Billed Charges,85% of total Billed Charges,240.8,80,,192.64,percent of total Billed Charges,80% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,189.63,63,,151.704,percent of total Billed Charges,63% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,189.63,63,,151.704,percent of total billed charges,63% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,240.8,80,,192.64,percent of total Billed Charges,80% of Total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,186.62,255.85,
"29581 Application of multilayer venous wnd comp, lower leg C",700055,CDM,361,RC,29581,HCPCS,Outpatient,,,301,210.7,,240.8,80,,192.64,percent of total Billed Charges,80% of Total Billed Charges,189.63,63,,151.704,percent of total Billed charges,63% of Total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total BIlled charges,189.63,63,,151.704,percent of total Billed Charges,63% of total Billed Charges,255.85,85,,204.68,percent of total Billed Charges,85% of total Billed Charges,240.8,80,,192.64,percent of total Billed Charges,80% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,189.63,63,,151.704,percent of total Billed Charges,63% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,189.63,63,,151.704,percent of total billed charges,63% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,240.8,80,,192.64,percent of total Billed Charges,80% of Total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,186.62,255.85,
20605 Aspiration/Injection intermediate joint/bursa Charge,700048,CDM,361,RC,20605,HCPCS,Outpatient,,,565,395.5,,452,80,,361.6,percent of total Billed Charges,80% of Total Billed Charges,355.95,63,,284.76,percent of total Billed charges,63% of Total Billed Charges,350.3,62,,280.24,percent of total Billed Charges,62% of total BIlled charges,355.95,63,,284.76,percent of total Billed Charges,63% of total Billed Charges,480.25,85,,384.2,percent of total Billed Charges,85% of total Billed Charges,452,80,,361.6,percent of total Billed Charges,80% of total Billed Charges,350.3,62,,280.24,percent of total Billed Charges,62% of total Billed Charges,355.95,63,,284.76,percent of total Billed Charges,63% of total Billed Charges,350.3,62,,280.24,percent of total Billed Charges,62% of total Billed Charges,355.95,63,,284.76,percent of total billed charges,63% of total Billed Charges,350.3,62,,280.24,percent of total Billed Charges,62% of total Billed Charges,452,80,,361.6,percent of total Billed Charges,80% of Total Billed Charges,350.3,62,,280.24,percent of total Billed Charges,62% of total Billed Charges,350.3,62,,280.24,percent of total Billed Charges,62% of total Billed Charges,350.3,480.25,
P9016 - E0316 RBC CPD AS1 500,141033,CDM,390,RC,,,Outpatient,,,597,417.9,,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,376.11,63,,300.888,percent of total Billed charges,63% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total BIlled charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,507.45,85,,405.96,percent of total Billed Charges,85% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total billed charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,507.45,
E0336 - RBC CPD AS1 500 LR,141033,CDM,390,RC,,,Outpatient,,,597,417.9,,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,376.11,63,,300.888,percent of total Billed charges,63% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total BIlled charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,507.45,85,,405.96,percent of total Billed Charges,85% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total billed charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,507.45,
P9016 - E0366 RBC CP2D AS3 500,141033,CDM,390,RC,,,Outpatient,,,597,417.9,,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,376.11,63,,300.888,percent of total Billed charges,63% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total BIlled charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,507.45,85,,405.96,percent of total Billed Charges,85% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total billed charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,507.45,
E0382 RBC CP2D AS3 500 LR,141033,CDM,390,RC,,,Outpatient,,,597,417.9,,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,376.11,63,,300.888,percent of total Billed charges,63% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total BIlled charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,507.45,85,,405.96,percent of total Billed Charges,85% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total billed charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,507.45,
E0424 - RBC CPD AS5 500 LR,141033,CDM,390,RC,,,Outpatient,,,597,417.9,,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,376.11,63,,300.888,percent of total Billed charges,63% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total BIlled charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,507.45,85,,405.96,percent of total Billed Charges,85% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total billed charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,507.45,
E2701 Thawed Plasma CPD <24h,140259,CDM,390,RC,,,Outpatient,,,230,161,,184,80,,147.2,percent of total Billed Charges,80% of Total Billed Charges,144.9,63,,115.92,percent of total Billed charges,63% of Total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total BIlled charges,144.9,63,,115.92,percent of total Billed Charges,63% of total Billed Charges,195.5,85,,156.4,percent of total Billed Charges,85% of total Billed Charges,184,80,,147.2,percent of total Billed Charges,80% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,144.9,63,,115.92,percent of total Billed Charges,63% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,144.9,63,,115.92,percent of total billed charges,63% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,184,80,,147.2,percent of total Billed Charges,80% of Total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,142.6,195.5,
E4306 Aph RBC ACDA,141033,CDM,390,RC,,,Outpatient,,,597,417.9,,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,376.11,63,,300.888,percent of total Billed charges,63% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total BIlled charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,507.45,85,,405.96,percent of total Billed Charges,85% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total billed charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,507.45,
E4306 Aph RBC ACDA,141033,CDM,390,RC,,,Outpatient,,,597,417.9,,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,376.11,63,,300.888,percent of total Billed charges,63% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total BIlled charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,507.45,85,,405.96,percent of total Billed Charges,85% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total billed charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,507.45,
E4379 Aph RBC ACDA LR,141033,CDM,390,RC,,,Outpatient,,,597,417.9,,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,376.11,63,,300.888,percent of total Billed charges,63% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total BIlled charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,507.45,85,,405.96,percent of total Billed Charges,85% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total billed charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,507.45,
E4524 Aph RBC ACDA AS1,140224,CDM,390,RC,,,Outpatient,,,896,627.2,,716.8,80,,573.44,percent of total Billed Charges,80% of Total Billed Charges,564.48,63,,451.584,percent of total Billed charges,63% of Total Billed Charges,555.52,62,,444.416,percent of total Billed Charges,62% of total BIlled charges,564.48,63,,451.584,percent of total Billed Charges,63% of total Billed Charges,761.6,85,,609.28,percent of total Billed Charges,85% of total Billed Charges,716.8,80,,573.44,percent of total Billed Charges,80% of total Billed Charges,555.52,62,,444.416,percent of total Billed Charges,62% of total Billed Charges,564.48,63,,451.584,percent of total Billed Charges,63% of total Billed Charges,555.52,62,,444.416,percent of total Billed Charges,62% of total Billed Charges,564.48,63,,451.584,percent of total billed charges,63% of total Billed Charges,555.52,62,,444.416,percent of total Billed Charges,62% of total Billed Charges,716.8,80,,573.44,percent of total Billed Charges,80% of Total Billed Charges,555.52,62,,444.416,percent of total Billed Charges,62% of total Billed Charges,555.52,62,,444.416,percent of total Billed Charges,62% of total Billed Charges,555.52,761.6,
E4532 Aph RBC ACDA AS1 LR 1,141033,CDM,390,RC,,,Outpatient,,,597,417.9,,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,376.11,63,,300.888,percent of total Billed charges,63% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total BIlled charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,507.45,85,,405.96,percent of total Billed Charges,85% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total billed charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,507.45,
E4533 Aph RBC ACDA AS1 LR 2,141033,CDM,390,RC,,,Outpatient,,,597,417.9,,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,376.11,63,,300.888,percent of total Billed charges,63% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total BIlled charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,507.45,85,,405.96,percent of total Billed Charges,85% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total billed charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,507.45,
E4536 Aph RBC ACDA AS3,141033,CDM,390,RC,,,Outpatient,,,597,417.9,,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,376.11,63,,300.888,percent of total Billed charges,63% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total BIlled charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,507.45,85,,405.96,percent of total Billed Charges,85% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total billed charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,507.45,
E4543 Aph RBC ACDA AS3 LR,141033,CDM,390,RC,,,Outpatient,,,597,417.9,,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,376.11,63,,300.888,percent of total Billed charges,63% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total BIlled charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,507.45,85,,405.96,percent of total Billed Charges,85% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total Billed Charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,376.11,63,,300.888,percent of total billed charges,63% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,477.6,80,,382.08,percent of total Billed Charges,80% of Total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,62,,296.112,percent of total Billed Charges,62% of total Billed Charges,370.14,507.45,
P9034 - E5033 Aph Plt ACDA LR BM3,140551,CDM,390,RC,,,Outpatient,,,2304,1612.8,,1843.2,80,,1474.56,percent of total Billed Charges,80% of Total Billed Charges,1451.52,63,,1161.216,percent of total Billed charges,63% of Total Billed Charges,1428.48,62,,1142.784,percent of total Billed Charges,62% of total BIlled charges,1451.52,63,,1161.216,percent of total Billed Charges,63% of total Billed Charges,1958.4,85,,1566.72,percent of total Billed Charges,85% of total Billed Charges,1843.2,80,,1474.56,percent of total Billed Charges,80% of total Billed Charges,1428.48,62,,1142.784,percent of total Billed Charges,62% of total Billed Charges,1451.52,63,,1161.216,percent of total Billed Charges,63% of total Billed Charges,1428.48,62,,1142.784,percent of total Billed Charges,62% of total Billed Charges,1451.52,63,,1161.216,percent of total billed charges,63% of total Billed Charges,1428.48,62,,1142.784,percent of total Billed Charges,62% of total Billed Charges,1843.2,80,,1474.56,percent of total Billed Charges,80% of Total Billed Charges,1428.48,62,,1142.784,percent of total Billed Charges,62% of total Billed Charges,1428.48,62,,1142.784,percent of total Billed Charges,62% of total Billed Charges,1428.48,1958.4,
E5157 RBC CPDAS5 LR LV Acadj,141033,CDM,390,RC,P9016,HCPCS,Outpatient,,,963,674.1,,770.4,80,,616.32,percent of total Billed Charges,80% of Total Billed Charges,606.69,63,,485.352,percent of total Billed charges,63% of Total Billed Charges,597.06,62,,477.648,percent of total Billed Charges,62% of total BIlled charges,606.69,63,,485.352,percent of total Billed Charges,63% of total Billed Charges,818.55,85,,654.84,percent of total Billed Charges,85% of total Billed Charges,770.4,80,,616.32,percent of total Billed Charges,80% of total Billed Charges,597.06,62,,477.648,percent of total Billed Charges,62% of total Billed Charges,606.69,63,,485.352,percent of total Billed Charges,63% of total Billed Charges,597.06,62,,477.648,percent of total Billed Charges,62% of total Billed Charges,606.69,63,,485.352,percent of total billed charges,63% of total Billed Charges,597.06,62,,477.648,percent of total Billed Charges,62% of total Billed Charges,770.4,80,,616.32,percent of total Billed Charges,80% of Total Billed Charges,597.06,62,,477.648,percent of total Billed Charges,62% of total Billed Charges,597.06,62,,477.648,percent of total Billed Charges,62% of total Billed Charges,597.06,818.55,
E7750 Thawed Aph Plas ACDA RT<24Frz<24 1,140259,CDM,390,RC,,,Outpatient,,,230,161,,184,80,,147.2,percent of total Billed Charges,80% of Total Billed Charges,144.9,63,,115.92,percent of total Billed charges,63% of Total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total BIlled charges,144.9,63,,115.92,percent of total Billed Charges,63% of total Billed Charges,195.5,85,,156.4,percent of total Billed Charges,85% of total Billed Charges,184,80,,147.2,percent of total Billed Charges,80% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,144.9,63,,115.92,percent of total Billed Charges,63% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,144.9,63,,115.92,percent of total billed charges,63% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,184,80,,147.2,percent of total Billed Charges,80% of Total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,142.6,195.5,
E7751 Thawed Aph Plas ACDA RT<24Frz<24 2,140259,CDM,390,RC,,,Outpatient,,,230,161,,184,80,,147.2,percent of total Billed Charges,80% of Total Billed Charges,144.9,63,,115.92,percent of total Billed charges,63% of Total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total BIlled charges,144.9,63,,115.92,percent of total Billed Charges,63% of total Billed Charges,195.5,85,,156.4,percent of total Billed Charges,85% of total Billed Charges,184,80,,147.2,percent of total Billed Charges,80% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,144.9,63,,115.92,percent of total Billed Charges,63% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,144.9,63,,115.92,percent of total billed charges,63% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,184,80,,147.2,percent of total Billed Charges,80% of Total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,142.6,195.5,
E7752 Thawed Aph Plas ACDA RT<24Frz<24 3,140259,CDM,390,RC,,,Outpatient,,,230,161,,184,80,,147.2,percent of total Billed Charges,80% of Total Billed Charges,144.9,63,,115.92,percent of total Billed charges,63% of Total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total BIlled charges,144.9,63,,115.92,percent of total Billed Charges,63% of total Billed Charges,195.5,85,,156.4,percent of total Billed Charges,85% of total Billed Charges,184,80,,147.2,percent of total Billed Charges,80% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,144.9,63,,115.92,percent of total Billed Charges,63% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,144.9,63,,115.92,percent of total billed charges,63% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,184,80,,147.2,percent of total Billed Charges,80% of Total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,142.6,195.5,
E7753 Thawed Aph Plas ACDA RT<24Fr<24 4,140259,CDM,390,RC,,,Outpatient,,,230,161,,184,80,,147.2,percent of total Billed Charges,80% of Total Billed Charges,144.9,63,,115.92,percent of total Billed charges,63% of Total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total BIlled charges,144.9,63,,115.92,percent of total Billed Charges,63% of total Billed Charges,195.5,85,,156.4,percent of total Billed Charges,85% of total Billed Charges,184,80,,147.2,percent of total Billed Charges,80% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,144.9,63,,115.92,percent of total Billed Charges,63% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,144.9,63,,115.92,percent of total billed charges,63% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,184,80,,147.2,percent of total Billed Charges,80% of Total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,142.6,195.5,
P9034 - E8331 Aph Plt ACDA>PASC LR Psoralen,140551,CDM,390,RC,,,Outpatient,,,2304,1612.8,,1843.2,80,,1474.56,percent of total Billed Charges,80% of Total Billed Charges,1451.52,63,,1161.216,percent of total Billed charges,63% of Total Billed Charges,1428.48,62,,1142.784,percent of total Billed Charges,62% of total BIlled charges,1451.52,63,,1161.216,percent of total Billed Charges,63% of total Billed Charges,1958.4,85,,1566.72,percent of total Billed Charges,85% of total Billed Charges,1843.2,80,,1474.56,percent of total Billed Charges,80% of total Billed Charges,1428.48,62,,1142.784,percent of total Billed Charges,62% of total Billed Charges,1451.52,63,,1161.216,percent of total Billed Charges,63% of total Billed Charges,1428.48,62,,1142.784,percent of total Billed Charges,62% of total Billed Charges,1451.52,63,,1161.216,percent of total billed charges,63% of total Billed Charges,1428.48,62,,1142.784,percent of total Billed Charges,62% of total Billed Charges,1843.2,80,,1474.56,percent of total Billed Charges,80% of Total Billed Charges,1428.48,62,,1142.784,percent of total Billed Charges,62% of total Billed Charges,1428.48,62,,1142.784,percent of total Billed Charges,62% of total Billed Charges,1428.48,1958.4,
36430 Blood Admin Charge,36430,CDM,391,RC,36430,HCPCS,Outpatient,,,582,407.4,,465.6,80,,372.48,percent of total Billed Charges,80% of Total Billed Charges,366.66,63,,293.328,percent of total Billed charges,63% of Total Billed Charges,360.84,62,,288.672,percent of total Billed Charges,62% of total BIlled charges,366.66,63,,293.328,percent of total Billed Charges,63% of total Billed Charges,494.7,85,,395.76,percent of total Billed Charges,85% of total Billed Charges,465.6,80,,372.48,percent of total Billed Charges,80% of total Billed Charges,360.84,62,,288.672,percent of total Billed Charges,62% of total Billed Charges,366.66,63,,293.328,percent of total Billed Charges,63% of total Billed Charges,360.84,62,,288.672,percent of total Billed Charges,62% of total Billed Charges,366.66,63,,293.328,percent of total billed charges,63% of total Billed Charges,360.84,62,,288.672,percent of total Billed Charges,62% of total Billed Charges,465.6,80,,372.48,percent of total Billed Charges,80% of Total Billed Charges,360.84,62,,288.672,percent of total Billed Charges,62% of total Billed Charges,360.84,62,,288.672,percent of total Billed Charges,62% of total Billed Charges,360.84,494.7,
36430 - BLOOD TRANSFUSION 1-4 HOURS,10068,CDM,391,RC,36430,HCPCS,Outpatient,,,582,407.4,,465.6,80,,372.48,percent of total Billed Charges,80% of Total Billed Charges,366.66,63,,293.328,percent of total Billed charges,63% of Total Billed Charges,360.84,62,,288.672,percent of total Billed Charges,62% of total BIlled charges,366.66,63,,293.328,percent of total Billed Charges,63% of total Billed Charges,494.7,85,,395.76,percent of total Billed Charges,85% of total Billed Charges,465.6,80,,372.48,percent of total Billed Charges,80% of total Billed Charges,360.84,62,,288.672,percent of total Billed Charges,62% of total Billed Charges,366.66,63,,293.328,percent of total Billed Charges,63% of total Billed Charges,360.84,62,,288.672,percent of total Billed Charges,62% of total Billed Charges,366.66,63,,293.328,percent of total billed charges,63% of total Billed Charges,360.84,62,,288.672,percent of total Billed Charges,62% of total Billed Charges,465.6,80,,372.48,percent of total Billed Charges,80% of Total Billed Charges,360.84,62,,288.672,percent of total Billed Charges,62% of total Billed Charges,360.84,62,,288.672,percent of total Billed Charges,62% of total Billed Charges,360.84,494.7,
36430 - BLOOD TRANSFUSION 4-8 HOURS,10068,CDM,391,RC,36430,HCPCS,Outpatient,,,582,407.4,,465.6,80,,372.48,percent of total Billed Charges,80% of Total Billed Charges,366.66,63,,293.328,percent of total Billed charges,63% of Total Billed Charges,360.84,62,,288.672,percent of total Billed Charges,62% of total BIlled charges,366.66,63,,293.328,percent of total Billed Charges,63% of total Billed Charges,494.7,85,,395.76,percent of total Billed Charges,85% of total Billed Charges,465.6,80,,372.48,percent of total Billed Charges,80% of total Billed Charges,360.84,62,,288.672,percent of total Billed Charges,62% of total Billed Charges,366.66,63,,293.328,percent of total Billed Charges,63% of total Billed Charges,360.84,62,,288.672,percent of total Billed Charges,62% of total Billed Charges,366.66,63,,293.328,percent of total billed charges,63% of total Billed Charges,360.84,62,,288.672,percent of total Billed Charges,62% of total Billed Charges,465.6,80,,372.48,percent of total Billed Charges,80% of Total Billed Charges,360.84,62,,288.672,percent of total Billed Charges,62% of total Billed Charges,360.84,62,,288.672,percent of total Billed Charges,62% of total Billed Charges,360.84,494.7,
51798 - Bladder Distention - Absent,10100,CDM,402,RC,51798,HCPCS,Outpatient,,,112,78.4,,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,70.56,63,,56.448,percent of total Billed charges,63% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total BIlled charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,95.2,85,,76.16,percent of total Billed Charges,85% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total billed charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,95.2,
51798 - Bladder Distention - Present,10100,CDM,402,RC,51798,HCPCS,Outpatient,,,112,78.4,,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,70.56,63,,56.448,percent of total Billed charges,63% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total BIlled charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,95.2,85,,76.16,percent of total Billed Charges,85% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total billed charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,95.2,
76706 - US AAA Screening,180148,CDM,402,RC,76706,HCPCS,Outpatient,,,345,241.5,,276,80,,220.8,percent of total Billed Charges,80% of Total Billed Charges,217.35,63,,173.88,percent of total Billed charges,63% of Total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total BIlled charges,217.35,63,,173.88,percent of total Billed Charges,63% of total Billed Charges,293.25,85,,234.6,percent of total Billed Charges,85% of total Billed Charges,276,80,,220.8,percent of total Billed Charges,80% of total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,217.35,63,,173.88,percent of total Billed Charges,63% of total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,217.35,63,,173.88,percent of total billed charges,63% of total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,276,80,,220.8,percent of total Billed Charges,80% of Total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,213.9,293.25,
76700 - US Abdomen Complete,180103,CDM,402,RC,76700,HCPCS,Outpatient,,,412,288.4,,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,259.56,63,,207.648,percent of total Billed charges,63% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total BIlled charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,350.2,85,,280.16,percent of total Billed Charges,85% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total billed charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,350.2,
76705 - US Abdomen Limited,180001,CDM,402,RC,76705,HCPCS,Outpatient,,,412,288.4,,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,259.56,63,,207.648,percent of total Billed charges,63% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total BIlled charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,350.2,85,,280.16,percent of total Billed Charges,85% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total billed charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,350.2,
76857 - US Bladder Scan,180135,CDM,402,RC,76857,HCPCS,Outpatient,,,345,241.5,,276,80,,220.8,percent of total Billed Charges,80% of Total Billed Charges,217.35,63,,173.88,percent of total Billed charges,63% of Total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total BIlled charges,217.35,63,,173.88,percent of total Billed Charges,63% of total Billed Charges,293.25,85,,234.6,percent of total Billed Charges,85% of total Billed Charges,276,80,,220.8,percent of total Billed Charges,80% of total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,217.35,63,,173.88,percent of total Billed Charges,63% of total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,217.35,63,,173.88,percent of total billed charges,63% of total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,276,80,,220.8,percent of total Billed Charges,80% of Total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,213.9,293.25,
76641 - US Breast Complete Left,180136,CDM,402,RC,76641,HCPCS,Outpatient,,,345,241.5,,276,80,,220.8,percent of total Billed Charges,80% of Total Billed Charges,217.35,63,,173.88,percent of total Billed charges,63% of Total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total BIlled charges,217.35,63,,173.88,percent of total Billed Charges,63% of total Billed Charges,293.25,85,,234.6,percent of total Billed Charges,85% of total Billed Charges,276,80,,220.8,percent of total Billed Charges,80% of total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,217.35,63,,173.88,percent of total Billed Charges,63% of total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,217.35,63,,173.88,percent of total billed charges,63% of total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,276,80,,220.8,percent of total Billed Charges,80% of Total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,213.9,293.25,
76641 - US Breast Complete Right,180136,CDM,402,RC,76641,HCPCS,Outpatient,,,345,241.5,,276,80,,220.8,percent of total Billed Charges,80% of Total Billed Charges,217.35,63,,173.88,percent of total Billed charges,63% of Total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total BIlled charges,217.35,63,,173.88,percent of total Billed Charges,63% of total Billed Charges,293.25,85,,234.6,percent of total Billed Charges,85% of total Billed Charges,276,80,,220.8,percent of total Billed Charges,80% of total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,217.35,63,,173.88,percent of total Billed Charges,63% of total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,217.35,63,,173.88,percent of total billed charges,63% of total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,276,80,,220.8,percent of total Billed Charges,80% of Total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,213.9,293.25,
76604 - US Chest,180115,CDM,402,RC,76604,HCPCS,Outpatient,,,412,288.4,,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,259.56,63,,207.648,percent of total Billed charges,63% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total BIlled charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,350.2,85,,280.16,percent of total Billed Charges,85% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total billed charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,350.2,
76881 - US Extremity Nonvascular Complete Left,180013,CDM,402,RC,76881,HCPCS,Outpatient,,,412,288.4,,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,259.56,63,,207.648,percent of total Billed charges,63% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total BIlled charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,350.2,85,,280.16,percent of total Billed Charges,85% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total billed charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,350.2,
76881 - US Extremity Nonvascular Complete Right,180013,CDM,402,RC,76881,HCPCS,Outpatient,,,412,288.4,,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,259.56,63,,207.648,percent of total Billed charges,63% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total BIlled charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,350.2,85,,280.16,percent of total Billed Charges,85% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total billed charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,350.2,
76882 - US Extremity Nonvascular Limited Left,180153,CDM,402,RC,76882,HCPCS,Outpatient,,,337,235.9,,269.6,80,,215.68,percent of total Billed Charges,80% of Total Billed Charges,212.31,63,,169.848,percent of total Billed charges,63% of Total Billed Charges,208.94,62,,167.152,percent of total Billed Charges,62% of total BIlled charges,212.31,63,,169.848,percent of total Billed Charges,63% of total Billed Charges,286.45,85,,229.16,percent of total Billed Charges,85% of total Billed Charges,269.6,80,,215.68,percent of total Billed Charges,80% of total Billed Charges,208.94,62,,167.152,percent of total Billed Charges,62% of total Billed Charges,212.31,63,,169.848,percent of total Billed Charges,63% of total Billed Charges,208.94,62,,167.152,percent of total Billed Charges,62% of total Billed Charges,212.31,63,,169.848,percent of total billed charges,63% of total Billed Charges,208.94,62,,167.152,percent of total Billed Charges,62% of total Billed Charges,269.6,80,,215.68,percent of total Billed Charges,80% of Total Billed Charges,208.94,62,,167.152,percent of total Billed Charges,62% of total Billed Charges,208.94,62,,167.152,percent of total Billed Charges,62% of total Billed Charges,208.94,286.45,
76882 - US Extremity Nonvascular Limited Right,180153,CDM,402,RC,76882,HCPCS,Outpatient,,,337,235.9,,269.6,80,,215.68,percent of total Billed Charges,80% of Total Billed Charges,212.31,63,,169.848,percent of total Billed charges,63% of Total Billed Charges,208.94,62,,167.152,percent of total Billed Charges,62% of total BIlled charges,212.31,63,,169.848,percent of total Billed Charges,63% of total Billed Charges,286.45,85,,229.16,percent of total Billed Charges,85% of total Billed Charges,269.6,80,,215.68,percent of total Billed Charges,80% of total Billed Charges,208.94,62,,167.152,percent of total Billed Charges,62% of total Billed Charges,212.31,63,,169.848,percent of total Billed Charges,63% of total Billed Charges,208.94,62,,167.152,percent of total Billed Charges,62% of total Billed Charges,212.31,63,,169.848,percent of total billed charges,63% of total Billed Charges,208.94,62,,167.152,percent of total Billed Charges,62% of total Billed Charges,269.6,80,,215.68,percent of total Billed Charges,80% of Total Billed Charges,208.94,62,,167.152,percent of total Billed Charges,62% of total Billed Charges,208.94,62,,167.152,percent of total Billed Charges,62% of total Billed Charges,208.94,286.45,
76942 - US Guided Needle Placement,180009,CDM,402,RC,76942,HCPCS,Outpatient,,,281,196.7,,224.8,80,,179.84,percent of total Billed Charges,80% of Total Billed Charges,177.03,63,,141.624,percent of total Billed charges,63% of Total Billed Charges,174.22,62,,139.376,percent of total Billed Charges,62% of total BIlled charges,177.03,63,,141.624,percent of total Billed Charges,63% of total Billed Charges,238.85,85,,191.08,percent of total Billed Charges,85% of total Billed Charges,224.8,80,,179.84,percent of total Billed Charges,80% of total Billed Charges,174.22,62,,139.376,percent of total Billed Charges,62% of total Billed Charges,177.03,63,,141.624,percent of total Billed Charges,63% of total Billed Charges,174.22,62,,139.376,percent of total Billed Charges,62% of total Billed Charges,177.03,63,,141.624,percent of total billed charges,63% of total Billed Charges,174.22,62,,139.376,percent of total Billed Charges,62% of total Billed Charges,224.8,80,,179.84,percent of total Billed Charges,80% of Total Billed Charges,174.22,62,,139.376,percent of total Billed Charges,62% of total Billed Charges,174.22,62,,139.376,percent of total Billed Charges,62% of total Billed Charges,174.22,238.85,
76536 - US Head/Neck Soft Tissue,180004,CDM,402,RC,76536,HCPCS,Outpatient,,,412,288.4,,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,259.56,63,,207.648,percent of total Billed charges,63% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total BIlled charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,350.2,85,,280.16,percent of total Billed Charges,85% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total billed charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,350.2,
76776 - US Kidney Transplant w/ Doppler,180123,CDM,402,RC,76776,HCPCS,Outpatient,,,412,288.4,,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,259.56,63,,207.648,percent of total Billed charges,63% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total BIlled charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,350.2,85,,280.16,percent of total Billed Charges,85% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total billed charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,350.2,
76810 - US OB < 14 Weeks Addl Fetus,180139,CDM,402,RC,76810,HCPCS,Outpatient,,,345,241.5,,276,80,,220.8,percent of total Billed Charges,80% of Total Billed Charges,217.35,63,,173.88,percent of total Billed charges,63% of Total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total BIlled charges,217.35,63,,173.88,percent of total Billed Charges,63% of total Billed Charges,293.25,85,,234.6,percent of total Billed Charges,85% of total Billed Charges,276,80,,220.8,percent of total Billed Charges,80% of total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,217.35,63,,173.88,percent of total Billed Charges,63% of total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,217.35,63,,173.88,percent of total billed charges,63% of total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,276,80,,220.8,percent of total Billed Charges,80% of Total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,213.9,62,,171.12,percent of total Billed Charges,62% of total Billed Charges,213.9,293.25,
76801 - US OB < 14 weeks,180122,CDM,402,RC,76801,HCPCS,Outpatient,,,412,288.4,,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,259.56,63,,207.648,percent of total Billed charges,63% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total BIlled charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,350.2,85,,280.16,percent of total Billed Charges,85% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total billed charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,350.2,
76817 - US OB Transvaginal,180117,CDM,402,RC,76817,HCPCS,Outpatient,,,412,288.4,,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,259.56,63,,207.648,percent of total Billed charges,63% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total BIlled charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,350.2,85,,280.16,percent of total Billed Charges,85% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total billed charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,350.2,
76856 - US Pelvic Non OB,180110,CDM,402,RC,76856,HCPCS,Outpatient,,,412,288.4,,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,259.56,63,,207.648,percent of total Billed charges,63% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total BIlled charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,350.2,85,,280.16,percent of total Billed Charges,85% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total billed charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,350.2,
76872 - US Prostate Transrectal,180152,CDM,402,RC,76872,HCPCS,Outpatient,,,412,288.4,,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,259.56,63,,207.648,percent of total Billed charges,63% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total BIlled charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,350.2,85,,280.16,percent of total Billed Charges,85% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total billed charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,350.2,
76770 - US Retroperitoneal Complete,180008,CDM,402,RC,76770,HCPCS,Outpatient,,,412,288.4,,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,259.56,63,,207.648,percent of total Billed charges,63% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total BIlled charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,350.2,85,,280.16,percent of total Billed Charges,85% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total billed charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,350.2,
76775 - US Retroperitoneal Limited,180114,CDM,402,RC,76775,HCPCS,Outpatient,,,412,288.4,,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,259.56,63,,207.648,percent of total Billed charges,63% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total BIlled charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,350.2,85,,280.16,percent of total Billed Charges,85% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total billed charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,350.2,
76870 - US Scrotum (Contents),180112,CDM,402,RC,76870,HCPCS,Outpatient,,,412,288.4,,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,259.56,63,,207.648,percent of total Billed charges,63% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total BIlled charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,350.2,85,,280.16,percent of total Billed Charges,85% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total billed charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,350.2,
US Soft Tissue,180156,CDM,402,RC,76999,HCPCS,Outpatient,,,261,182.7,,208.8,80,,167.04,percent of total Billed Charges,80% of Total Billed Charges,164.43,63,,131.544,percent of total Billed charges,63% of Total Billed Charges,161.82,62,,129.456,percent of total Billed Charges,62% of total BIlled charges,164.43,63,,131.544,percent of total Billed Charges,63% of total Billed Charges,221.85,85,,177.48,percent of total Billed Charges,85% of total Billed Charges,208.8,80,,167.04,percent of total Billed Charges,80% of total Billed Charges,161.82,62,,129.456,percent of total Billed Charges,62% of total Billed Charges,164.43,63,,131.544,percent of total Billed Charges,63% of total Billed Charges,161.82,62,,129.456,percent of total Billed Charges,62% of total Billed Charges,164.43,63,,131.544,percent of total billed charges,63% of total Billed Charges,161.82,62,,129.456,percent of total Billed Charges,62% of total Billed Charges,208.8,80,,167.04,percent of total Billed Charges,80% of Total Billed Charges,161.82,62,,129.456,percent of total Billed Charges,62% of total Billed Charges,161.82,62,,129.456,percent of total Billed Charges,62% of total Billed Charges,161.82,221.85,
76536 - US Thyroid,180015,CDM,402,RC,76536,HCPCS,Outpatient,,,412,288.4,,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,259.56,63,,207.648,percent of total Billed charges,63% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total BIlled charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,350.2,85,,280.16,percent of total Billed Charges,85% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total billed charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,350.2,
76830 - US Transvaginal Non-OB,180109,CDM,402,RC,76830,HCPCS,Outpatient,,,412,288.4,,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,259.56,63,,207.648,percent of total Billed charges,63% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total BIlled charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,350.2,85,,280.16,percent of total Billed Charges,85% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total Billed Charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,259.56,63,,207.648,percent of total billed charges,63% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,329.6,80,,263.68,percent of total Billed Charges,80% of Total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,62,,204.352,percent of total Billed Charges,62% of total Billed Charges,255.44,350.2,
Introduction of a new tracheostomy tube,150113,CDM,410,RC,31502,HCPCS,Outpatient,,,355,248.5,59,284,80,,227.2,percent of total Billed Charges,80% of Total Billed Charges,223.65,63,,178.92,percent of total Billed charges,63% of Total Billed Charges,220.1,62,,176.08,percent of total Billed Charges,62% of total BIlled charges,223.65,63,,178.92,percent of total Billed Charges,63% of total Billed Charges,301.75,85,,241.4,percent of total Billed Charges,85% of total Billed Charges,284,80,,227.2,percent of total Billed Charges,80% of total Billed Charges,220.1,62,,176.08,percent of total Billed Charges,62% of total Billed Charges,223.65,63,,178.92,percent of total Billed Charges,63% of total Billed Charges,220.1,62,,176.08,percent of total Billed Charges,62% of total Billed Charges,223.65,63,,178.92,percent of total billed charges,63% of total Billed Charges,220.1,62,,176.08,percent of total Billed Charges,62% of total Billed Charges,284,80,,227.2,percent of total Billed Charges,80% of Total Billed Charges,220.1,62,,176.08,percent of total Billed Charges,62% of total Billed Charges,220.1,62,,176.08,percent of total Billed Charges,62% of total Billed Charges,220.1,301.75,
94660 - CPAP vent initiat/manage,441009,CDM,410,RC,94660,HCPCS,Outpatient,,,373,261.1,59,298.4,80,,238.72,percent of total Billed Charges,80% of Total Billed Charges,234.99,63,,187.992,percent of total Billed charges,63% of Total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total BIlled charges,234.99,63,,187.992,percent of total Billed Charges,63% of total Billed Charges,317.05,85,,253.64,percent of total Billed Charges,85% of total Billed Charges,298.4,80,,238.72,percent of total Billed Charges,80% of total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total Billed Charges,234.99,63,,187.992,percent of total Billed Charges,63% of total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total Billed Charges,234.99,63,,187.992,percent of total billed charges,63% of total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total Billed Charges,298.4,80,,238.72,percent of total Billed Charges,80% of Total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total Billed Charges,231.26,317.05,
94664 - Demo/eval/pt use aerosol/neb/IPPB,441010,CDM,410,RC,94664,HCPCS,Outpatient,,,373,261.1,59,298.4,80,,238.72,percent of total Billed Charges,80% of Total Billed Charges,234.99,63,,187.992,percent of total Billed charges,63% of Total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total BIlled charges,234.99,63,,187.992,percent of total Billed Charges,63% of total Billed Charges,317.05,85,,253.64,percent of total Billed Charges,85% of total Billed Charges,298.4,80,,238.72,percent of total Billed Charges,80% of total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total Billed Charges,234.99,63,,187.992,percent of total Billed Charges,63% of total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total Billed Charges,234.99,63,,187.992,percent of total billed charges,63% of total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total Billed Charges,298.4,80,,238.72,percent of total Billed Charges,80% of Total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total Billed Charges,231.26,317.05,
94729 - Diffusing capacity/CO2/add on,441023,CDM,410,RC,94729,HCPCS,Outpatient,,,408,285.6,59,326.4,80,,261.12,percent of total Billed Charges,80% of Total Billed Charges,257.04,63,,205.632,percent of total Billed charges,63% of Total Billed Charges,252.96,62,,202.368,percent of total Billed Charges,62% of total BIlled charges,257.04,63,,205.632,percent of total Billed Charges,63% of total Billed Charges,346.8,85,,277.44,percent of total Billed Charges,85% of total Billed Charges,326.4,80,,261.12,percent of total Billed Charges,80% of total Billed Charges,252.96,62,,202.368,percent of total Billed Charges,62% of total Billed Charges,257.04,63,,205.632,percent of total Billed Charges,63% of total Billed Charges,252.96,62,,202.368,percent of total Billed Charges,62% of total Billed Charges,257.04,63,,205.632,percent of total billed charges,63% of total Billed Charges,252.96,62,,202.368,percent of total Billed Charges,62% of total Billed Charges,326.4,80,,261.12,percent of total Billed Charges,80% of Total Billed Charges,252.96,62,,202.368,percent of total Billed Charges,62% of total Billed Charges,252.96,62,,202.368,percent of total Billed Charges,62% of total Billed Charges,252.96,346.8,
94667 - Manip chest wall/init demo/eval,441011,CDM,410,RC,94667,HCPCS,Outpatient,,,210,147,59,168,80,,134.4,percent of total Billed Charges,80% of Total Billed Charges,132.3,63,,105.84,percent of total Billed charges,63% of Total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total BIlled charges,132.3,63,,105.84,percent of total Billed Charges,63% of total Billed Charges,178.5,85,,142.8,percent of total Billed Charges,85% of total Billed Charges,168,80,,134.4,percent of total Billed Charges,80% of total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,132.3,63,,105.84,percent of total Billed Charges,63% of total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,132.3,63,,105.84,percent of total billed charges,63% of total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,168,80,,134.4,percent of total Billed Charges,80% of Total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,130.2,178.5,
94668 - Manip chest wall/subseq demo/eval,441012,CDM,410,RC,94668,HCPCS,Outpatient,,,210,147,59,168,80,,134.4,percent of total Billed Charges,80% of Total Billed Charges,132.3,63,,105.84,percent of total Billed charges,63% of Total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total BIlled charges,132.3,63,,105.84,percent of total Billed Charges,63% of total Billed Charges,178.5,85,,142.8,percent of total Billed Charges,85% of total Billed Charges,168,80,,134.4,percent of total Billed Charges,80% of total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,132.3,63,,105.84,percent of total Billed Charges,63% of total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,132.3,63,,105.84,percent of total billed charges,63% of total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,168,80,,134.4,percent of total Billed Charges,80% of Total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,130.2,178.5,
94669 - Mechanical chest wall oscillation to facilitate lung function 94669,441013,CDM,410,RC,94669,HCPCS,Outpatient,,,373,261.1,59,298.4,80,,238.72,percent of total Billed Charges,80% of Total Billed Charges,234.99,63,,187.992,percent of total Billed charges,63% of Total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total BIlled charges,234.99,63,,187.992,percent of total Billed Charges,63% of total Billed Charges,317.05,85,,253.64,percent of total Billed Charges,85% of total Billed Charges,298.4,80,,238.72,percent of total Billed Charges,80% of total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total Billed Charges,234.99,63,,187.992,percent of total Billed Charges,63% of total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total Billed Charges,234.99,63,,187.992,percent of total billed charges,63% of total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total Billed Charges,298.4,80,,238.72,percent of total Billed Charges,80% of Total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total Billed Charges,231.26,317.05,
94010 - BEDSIDE SPIROMETRY,150133,CDM,410,RC,94010,HCPCS,Outpatient,,,277,193.9,59,221.6,80,,177.28,percent of total Billed Charges,80% of Total Billed Charges,174.51,63,,139.608,percent of total Billed charges,63% of Total Billed Charges,171.74,62,,137.392,percent of total Billed Charges,62% of total BIlled charges,174.51,63,,139.608,percent of total Billed Charges,63% of total Billed Charges,235.45,85,,188.36,percent of total Billed Charges,85% of total Billed Charges,221.6,80,,177.28,percent of total Billed Charges,80% of total Billed Charges,171.74,62,,137.392,percent of total Billed Charges,62% of total Billed Charges,174.51,63,,139.608,percent of total Billed Charges,63% of total Billed Charges,171.74,62,,137.392,percent of total Billed Charges,62% of total Billed Charges,174.51,63,,139.608,percent of total billed charges,63% of total Billed Charges,171.74,62,,137.392,percent of total Billed Charges,62% of total Billed Charges,221.6,80,,177.28,percent of total Billed Charges,80% of Total Billed Charges,171.74,62,,137.392,percent of total Billed Charges,62% of total Billed Charges,171.74,62,,137.392,percent of total Billed Charges,62% of total Billed Charges,171.74,235.45,
94640 - RT Aerosol Initial CHARGE,150015,CDM,410,RC,94640,HCPCS,Outpatient,,,325,227.5,59,260,80,,208,percent of total Billed Charges,80% of Total Billed Charges,204.75,63,,163.8,percent of total Billed charges,63% of Total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total BIlled charges,204.75,63,,163.8,percent of total Billed Charges,63% of total Billed Charges,276.25,85,,221,percent of total Billed Charges,85% of total Billed Charges,260,80,,208,percent of total Billed Charges,80% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,204.75,63,,163.8,percent of total Billed Charges,63% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,204.75,63,,163.8,percent of total billed charges,63% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,260,80,,208,percent of total Billed Charges,80% of Total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,201.5,276.25,
94664 - RT Aerosol Therapy Instruction CHARGE,150034,CDM,410,RC,94664,HCPCS,Outpatient,,,200,140,59,160,80,,128,percent of total Billed Charges,80% of Total Billed Charges,126,63,,100.8,percent of total Billed charges,63% of Total Billed Charges,124,62,,99.2,percent of total Billed Charges,62% of total BIlled charges,126,63,,100.8,percent of total Billed Charges,63% of total Billed Charges,170,85,,136,percent of total Billed Charges,85% of total Billed Charges,160,80,,128,percent of total Billed Charges,80% of total Billed Charges,124,62,,99.2,percent of total Billed Charges,62% of total Billed Charges,126,63,,100.8,percent of total Billed Charges,63% of total Billed Charges,124,62,,99.2,percent of total Billed Charges,62% of total Billed Charges,126,63,,100.8,percent of total billed charges,63% of total Billed Charges,124,62,,99.2,percent of total Billed Charges,62% of total Billed Charges,160,80,,128,percent of total Billed Charges,80% of Total Billed Charges,124,62,,99.2,percent of total Billed Charges,62% of total Billed Charges,124,62,,99.2,percent of total Billed Charges,62% of total Billed Charges,124,170,
31720 - RT Airway Suction CHARGE,150112,CDM,410,RC,31720,HCPCS,Outpatient,,,325,227.5,59,260,80,,208,percent of total Billed Charges,80% of Total Billed Charges,204.75,63,,163.8,percent of total Billed charges,63% of Total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total BIlled charges,204.75,63,,163.8,percent of total Billed Charges,63% of total Billed Charges,276.25,85,,221,percent of total Billed Charges,85% of total Billed Charges,260,80,,208,percent of total Billed Charges,80% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,204.75,63,,163.8,percent of total Billed Charges,63% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,204.75,63,,163.8,percent of total billed charges,63% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,260,80,,208,percent of total Billed Charges,80% of Total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,201.5,276.25,
CPAP ventilation,150085,CDM,410,RC,94660,HCPCS,Outpatient,,,325,227.5,59,260,80,,208,percent of total Billed Charges,80% of Total Billed Charges,204.75,63,,163.8,percent of total Billed charges,63% of Total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total BIlled charges,204.75,63,,163.8,percent of total Billed Charges,63% of total Billed Charges,276.25,85,,221,percent of total Billed Charges,85% of total Billed Charges,260,80,,208,percent of total Billed Charges,80% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,204.75,63,,163.8,percent of total Billed Charges,63% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,204.75,63,,163.8,percent of total billed charges,63% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,260,80,,208,percent of total Billed Charges,80% of Total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,201.5,276.25,
CPAP ventilation,150085,CDM,410,RC,94660,HCPCS,Outpatient,,,325,227.5,59,260,80,,208,percent of total Billed Charges,80% of Total Billed Charges,204.75,63,,163.8,percent of total Billed charges,63% of Total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total BIlled charges,204.75,63,,163.8,percent of total Billed Charges,63% of total Billed Charges,276.25,85,,221,percent of total Billed Charges,85% of total Billed Charges,260,80,,208,percent of total Billed Charges,80% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,204.75,63,,163.8,percent of total Billed Charges,63% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,204.75,63,,163.8,percent of total billed charges,63% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,260,80,,208,percent of total Billed Charges,80% of Total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,201.5,276.25,
94660 - RT CPAP Initial CHARGE,150085,CDM,410,RC,94660,HCPCS,Outpatient,,,325,227.5,59,260,80,,208,percent of total Billed Charges,80% of Total Billed Charges,204.75,63,,163.8,percent of total Billed charges,63% of Total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total BIlled charges,204.75,63,,163.8,percent of total Billed Charges,63% of total Billed Charges,276.25,85,,221,percent of total Billed Charges,85% of total Billed Charges,260,80,,208,percent of total Billed Charges,80% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,204.75,63,,163.8,percent of total Billed Charges,63% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,204.75,63,,163.8,percent of total billed charges,63% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,260,80,,208,percent of total Billed Charges,80% of Total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,201.5,276.25,
94660 - RT CPAP Subsequent CHARGE,150085,CDM,410,RC,94660,HCPCS,Outpatient,,,325,227.5,59,260,80,,208,percent of total Billed Charges,80% of Total Billed Charges,204.75,63,,163.8,percent of total Billed charges,63% of Total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total BIlled charges,204.75,63,,163.8,percent of total Billed Charges,63% of total Billed Charges,276.25,85,,221,percent of total Billed Charges,85% of total Billed Charges,260,80,,208,percent of total Billed Charges,80% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,204.75,63,,163.8,percent of total Billed Charges,63% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,204.75,63,,163.8,percent of total billed charges,63% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,260,80,,208,percent of total Billed Charges,80% of Total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,201.5,276.25,
94667 - RT CPT Initial CHARGE,150001,CDM,410,RC,94667,HCPCS,Outpatient,,,200,140,59,160,80,,128,percent of total Billed Charges,80% of Total Billed Charges,126,63,,100.8,percent of total Billed charges,63% of Total Billed Charges,124,62,,99.2,percent of total Billed Charges,62% of total BIlled charges,126,63,,100.8,percent of total Billed Charges,63% of total Billed Charges,170,85,,136,percent of total Billed Charges,85% of total Billed Charges,160,80,,128,percent of total Billed Charges,80% of total Billed Charges,124,62,,99.2,percent of total Billed Charges,62% of total Billed Charges,126,63,,100.8,percent of total Billed Charges,63% of total Billed Charges,124,62,,99.2,percent of total Billed Charges,62% of total Billed Charges,126,63,,100.8,percent of total billed charges,63% of total Billed Charges,124,62,,99.2,percent of total Billed Charges,62% of total Billed Charges,160,80,,128,percent of total Billed Charges,80% of Total Billed Charges,124,62,,99.2,percent of total Billed Charges,62% of total Billed Charges,124,62,,99.2,percent of total Billed Charges,62% of total Billed Charges,124,170,
94668 - RT CPT Subsequent CHARGE,150002,CDM,410,RC,94668,HCPCS,Outpatient,,,200,140,59,160,80,,128,percent of total Billed Charges,80% of Total Billed Charges,126,63,,100.8,percent of total Billed charges,63% of Total Billed Charges,124,62,,99.2,percent of total Billed Charges,62% of total BIlled charges,126,63,,100.8,percent of total Billed Charges,63% of total Billed Charges,170,85,,136,percent of total Billed Charges,85% of total Billed Charges,160,80,,128,percent of total Billed Charges,80% of total Billed Charges,124,62,,99.2,percent of total Billed Charges,62% of total Billed Charges,126,63,,100.8,percent of total Billed Charges,63% of total Billed Charges,124,62,,99.2,percent of total Billed Charges,62% of total Billed Charges,126,63,,100.8,percent of total billed charges,63% of total Billed Charges,124,62,,99.2,percent of total Billed Charges,62% of total Billed Charges,160,80,,128,percent of total Billed Charges,80% of Total Billed Charges,124,62,,99.2,percent of total Billed Charges,62% of total Billed Charges,124,62,,99.2,percent of total Billed Charges,62% of total Billed Charges,124,170,
94669 - RT CPT w/ Vest Initial CHARGE,150120,CDM,410,RC,94669,HCPCS,Outpatient,,,368,257.6,59,294.4,80,,235.52,percent of total Billed Charges,80% of Total Billed Charges,231.84,63,,185.472,percent of total Billed charges,63% of Total Billed Charges,228.16,62,,182.528,percent of total Billed Charges,62% of total BIlled charges,231.84,63,,185.472,percent of total Billed Charges,63% of total Billed Charges,312.8,85,,250.24,percent of total Billed Charges,85% of total Billed Charges,294.4,80,,235.52,percent of total Billed Charges,80% of total Billed Charges,228.16,62,,182.528,percent of total Billed Charges,62% of total Billed Charges,231.84,63,,185.472,percent of total Billed Charges,63% of total Billed Charges,228.16,62,,182.528,percent of total Billed Charges,62% of total Billed Charges,231.84,63,,185.472,percent of total billed charges,63% of total Billed Charges,228.16,62,,182.528,percent of total Billed Charges,62% of total Billed Charges,294.4,80,,235.52,percent of total Billed Charges,80% of Total Billed Charges,228.16,62,,182.528,percent of total Billed Charges,62% of total Billed Charges,228.16,62,,182.528,percent of total Billed Charges,62% of total Billed Charges,228.16,312.8,
94669 - RT CPT w/ Vest Subsequent CHARGE,150120,CDM,410,RC,94669,HCPCS,Outpatient,,,368,257.6,59,294.4,80,,235.52,percent of total Billed Charges,80% of Total Billed Charges,231.84,63,,185.472,percent of total Billed charges,63% of Total Billed Charges,228.16,62,,182.528,percent of total Billed Charges,62% of total BIlled charges,231.84,63,,185.472,percent of total Billed Charges,63% of total Billed Charges,312.8,85,,250.24,percent of total Billed Charges,85% of total Billed Charges,294.4,80,,235.52,percent of total Billed Charges,80% of total Billed Charges,228.16,62,,182.528,percent of total Billed Charges,62% of total Billed Charges,231.84,63,,185.472,percent of total Billed Charges,63% of total Billed Charges,228.16,62,,182.528,percent of total Billed Charges,62% of total Billed Charges,231.84,63,,185.472,percent of total billed charges,63% of total Billed Charges,228.16,62,,182.528,percent of total Billed Charges,62% of total Billed Charges,294.4,80,,235.52,percent of total Billed Charges,80% of Total Billed Charges,228.16,62,,182.528,percent of total Billed Charges,62% of total Billed Charges,228.16,62,,182.528,percent of total Billed Charges,62% of total Billed Charges,228.16,312.8,
92950 - RT Cardiopulmonary Resuscitation CHARGE,150084,CDM,410,RC,92950,HCPCS,Outpatient,,,465,325.5,59,372,80,,297.6,percent of total Billed Charges,80% of Total Billed Charges,292.95,63,,234.36,percent of total Billed charges,63% of Total Billed Charges,288.3,62,,230.64,percent of total Billed Charges,62% of total BIlled charges,292.95,63,,234.36,percent of total Billed Charges,63% of total Billed Charges,395.25,85,,316.2,percent of total Billed Charges,85% of total Billed Charges,372,80,,297.6,percent of total Billed Charges,80% of total Billed Charges,288.3,62,,230.64,percent of total Billed Charges,62% of total Billed Charges,292.95,63,,234.36,percent of total Billed Charges,63% of total Billed Charges,288.3,62,,230.64,percent of total Billed Charges,62% of total Billed Charges,292.95,63,,234.36,percent of total billed charges,63% of total Billed Charges,288.3,62,,230.64,percent of total Billed Charges,62% of total Billed Charges,372,80,,297.6,percent of total Billed Charges,80% of Total Billed Charges,288.3,62,,230.64,percent of total Billed Charges,62% of total Billed Charges,288.3,62,,230.64,percent of total Billed Charges,62% of total Billed Charges,288.3,395.25,
94644 - RT Continuous Neb Initial CHARGE,150115,CDM,410,RC,94644,HCPCS,Outpatient,,,201,140.7,59,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,126.63,63,,101.304,percent of total Billed charges,63% of Total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total BIlled charges,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,170.85,85,,136.68,percent of total Billed Charges,85% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,126.63,63,,101.304,percent of total billed charges,63% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,124.62,170.85,
94645 - RT Continuous Neb Subsequent CHARGE,150116,CDM,410,RC,94645,HCPCS,Outpatient,,,39,27.3,59,31.2,80,,24.96,percent of total Billed Charges,80% of Total Billed Charges,24.57,63,,19.656,percent of total Billed charges,63% of Total Billed Charges,24.18,62,,19.344,percent of total Billed Charges,62% of total BIlled charges,24.57,63,,19.656,percent of total Billed Charges,63% of total Billed Charges,33.15,85,,26.52,percent of total Billed Charges,85% of total Billed Charges,31.2,80,,24.96,percent of total Billed Charges,80% of total Billed Charges,24.18,62,,19.344,percent of total Billed Charges,62% of total Billed Charges,24.57,63,,19.656,percent of total Billed Charges,63% of total Billed Charges,24.18,62,,19.344,percent of total Billed Charges,62% of total Billed Charges,24.57,63,,19.656,percent of total billed charges,63% of total Billed Charges,24.18,62,,19.344,percent of total Billed Charges,62% of total Billed Charges,31.2,80,,24.96,percent of total Billed Charges,80% of Total Billed Charges,24.18,62,,19.344,percent of total Billed Charges,62% of total Billed Charges,24.18,62,,19.344,percent of total Billed Charges,62% of total Billed Charges,24.18,33.15,
31500 - RT Intubation Assist CHARGE,150041,CDM,410,RC,31500,HCPCS,Outpatient,,,355,248.5,59,284,80,,227.2,percent of total Billed Charges,80% of Total Billed Charges,223.65,63,,178.92,percent of total Billed charges,63% of Total Billed Charges,220.1,62,,176.08,percent of total Billed Charges,62% of total BIlled charges,223.65,63,,178.92,percent of total Billed Charges,63% of total Billed Charges,301.75,85,,241.4,percent of total Billed Charges,85% of total Billed Charges,284,80,,227.2,percent of total Billed Charges,80% of total Billed Charges,220.1,62,,176.08,percent of total Billed Charges,62% of total Billed Charges,223.65,63,,178.92,percent of total Billed Charges,63% of total Billed Charges,220.1,62,,176.08,percent of total Billed Charges,62% of total Billed Charges,223.65,63,,178.92,percent of total billed charges,63% of total Billed Charges,220.1,62,,176.08,percent of total Billed Charges,62% of total Billed Charges,284,80,,227.2,percent of total Billed Charges,80% of Total Billed Charges,220.1,62,,176.08,percent of total Billed Charges,62% of total Billed Charges,220.1,62,,176.08,percent of total Billed Charges,62% of total Billed Charges,220.1,301.75,
94640 - RT Meter Dose Inhaler Initial CHARGE,150015,CDM,410,RC,94640,HCPCS,Outpatient,,,325,227.5,59,260,80,,208,percent of total Billed Charges,80% of Total Billed Charges,204.75,63,,163.8,percent of total Billed charges,63% of Total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total BIlled charges,204.75,63,,163.8,percent of total Billed Charges,63% of total Billed Charges,276.25,85,,221,percent of total Billed Charges,85% of total Billed Charges,260,80,,208,percent of total Billed Charges,80% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,204.75,63,,163.8,percent of total Billed Charges,63% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,204.75,63,,163.8,percent of total billed charges,63% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,260,80,,208,percent of total Billed Charges,80% of Total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,201.5,276.25,
94618 - RT Pulse Oximetry Exercise CHARGE,150119,CDM,410,RC,94618,HCPCS,Outpatient,,,300,210,59,240,80,,192,percent of total Billed Charges,80% of Total Billed Charges,189,63,,151.2,percent of total Billed charges,63% of Total Billed Charges,186,62,,148.8,percent of total Billed Charges,62% of total BIlled charges,189,63,,151.2,percent of total Billed Charges,63% of total Billed Charges,255,85,,204,percent of total Billed Charges,85% of total Billed Charges,240,80,,192,percent of total Billed Charges,80% of total Billed Charges,186,62,,148.8,percent of total Billed Charges,62% of total Billed Charges,189,63,,151.2,percent of total Billed Charges,63% of total Billed Charges,186,62,,148.8,percent of total Billed Charges,62% of total Billed Charges,189,63,,151.2,percent of total billed charges,63% of total Billed Charges,186,62,,148.8,percent of total Billed Charges,62% of total Billed Charges,240,80,,192,percent of total Billed Charges,80% of Total Billed Charges,186,62,,148.8,percent of total Billed Charges,62% of total Billed Charges,186,62,,148.8,percent of total Billed Charges,62% of total Billed Charges,186,255,
94640 - RT Sputum Induction Initial CHARGE,150129,CDM,410,RC,94640,HCPCS,Outpatient,,,325,227.5,59,260,80,,208,percent of total Billed Charges,80% of Total Billed Charges,204.75,63,,163.8,percent of total Billed charges,63% of Total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total BIlled charges,204.75,63,,163.8,percent of total Billed Charges,63% of total Billed Charges,276.25,85,,221,percent of total Billed Charges,85% of total Billed Charges,260,80,,208,percent of total Billed Charges,80% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,204.75,63,,163.8,percent of total Billed Charges,63% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,204.75,63,,163.8,percent of total billed charges,63% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,260,80,,208,percent of total Billed Charges,80% of Total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,201.5,62,,161.2,percent of total Billed Charges,62% of total Billed Charges,201.5,276.25,
94002 - RT Ventilator Services Initial CHARGE,150022,CDM,410,RC,94002,HCPCS,Outpatient,,,848,593.6,59,678.4,80,,542.72,percent of total Billed Charges,80% of Total Billed Charges,534.24,63,,427.392,percent of total Billed charges,63% of Total Billed Charges,525.76,62,,420.608,percent of total Billed Charges,62% of total BIlled charges,534.24,63,,427.392,percent of total Billed Charges,63% of total Billed Charges,720.8,85,,576.64,percent of total Billed Charges,85% of total Billed Charges,678.4,80,,542.72,percent of total Billed Charges,80% of total Billed Charges,525.76,62,,420.608,percent of total Billed Charges,62% of total Billed Charges,534.24,63,,427.392,percent of total Billed Charges,63% of total Billed Charges,525.76,62,,420.608,percent of total Billed Charges,62% of total Billed Charges,534.24,63,,427.392,percent of total billed charges,63% of total Billed Charges,525.76,62,,420.608,percent of total Billed Charges,62% of total Billed Charges,678.4,80,,542.72,percent of total Billed Charges,80% of Total Billed Charges,525.76,62,,420.608,percent of total Billed Charges,62% of total Billed Charges,525.76,62,,420.608,percent of total Billed Charges,62% of total Billed Charges,525.76,720.8,
94003 - RT Ventilator Services Subsequent CHARGE,150003,CDM,410,RC,94003,HCPCS,Outpatient,,,713,499.1,59,570.4,80,,456.32,percent of total Billed Charges,80% of Total Billed Charges,449.19,63,,359.352,percent of total Billed charges,63% of Total Billed Charges,442.06,62,,353.648,percent of total Billed Charges,62% of total BIlled charges,449.19,63,,359.352,percent of total Billed Charges,63% of total Billed Charges,606.05,85,,484.84,percent of total Billed Charges,85% of total Billed Charges,570.4,80,,456.32,percent of total Billed Charges,80% of total Billed Charges,442.06,62,,353.648,percent of total Billed Charges,62% of total Billed Charges,449.19,63,,359.352,percent of total Billed Charges,63% of total Billed Charges,442.06,62,,353.648,percent of total Billed Charges,62% of total Billed Charges,449.19,63,,359.352,percent of total billed charges,63% of total Billed Charges,442.06,62,,353.648,percent of total Billed Charges,62% of total Billed Charges,570.4,80,,456.32,percent of total Billed Charges,80% of Total Billed Charges,442.06,62,,353.648,percent of total Billed Charges,62% of total Billed Charges,442.06,62,,353.648,percent of total Billed Charges,62% of total Billed Charges,442.06,606.05,
PT Attended E-Stim Assistant Units,110208,CDM,420,RC,97032,HCPCS,Outpatient,,,51,35.7,GP,40.8,80,,32.64,percent of total Billed Charges,80% of Total Billed Charges,32.13,63,,25.704,percent of total Billed charges,63% of Total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total BIlled charges,32.13,63,,25.704,percent of total Billed Charges,63% of total Billed Charges,43.35,85,,34.68,percent of total Billed Charges,85% of total Billed Charges,40.8,80,,32.64,percent of total Billed Charges,80% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,32.13,63,,25.704,percent of total Billed Charges,63% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,32.13,63,,25.704,percent of total billed charges,63% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,40.8,80,,32.64,percent of total Billed Charges,80% of Total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,31.62,43.35,
97032 PT Attended E-stim Units,110208,CDM,420,RC,97032,HCPCS,Outpatient,,,51,35.7,GP,40.8,80,,32.64,percent of total Billed Charges,80% of Total Billed Charges,32.13,63,,25.704,percent of total Billed charges,63% of Total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total BIlled charges,32.13,63,,25.704,percent of total Billed Charges,63% of total Billed Charges,43.35,85,,34.68,percent of total Billed Charges,85% of total Billed Charges,40.8,80,,32.64,percent of total Billed Charges,80% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,32.13,63,,25.704,percent of total Billed Charges,63% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,32.13,63,,25.704,percent of total billed charges,63% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,40.8,80,,32.64,percent of total Billed Charges,80% of Total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,31.62,43.35,
PT Gait Training Assistant Units,110331,CDM,420,RC,97116,HCPCS,Outpatient,,,75,52.5,GP,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,47.25,63,,37.8,percent of total Billed charges,63% of Total Billed Charges,46.5,62,,37.2,percent of total Billed Charges,62% of total BIlled charges,47.25,63,,37.8,percent of total Billed Charges,63% of total Billed Charges,63.75,85,,51,percent of total Billed Charges,85% of total Billed Charges,60,80,,48,percent of total Billed Charges,80% of total Billed Charges,46.5,62,,37.2,percent of total Billed Charges,62% of total Billed Charges,47.25,63,,37.8,percent of total Billed Charges,63% of total Billed Charges,46.5,62,,37.2,percent of total Billed Charges,62% of total Billed Charges,47.25,63,,37.8,percent of total billed charges,63% of total Billed Charges,46.5,62,,37.2,percent of total Billed Charges,62% of total Billed Charges,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,46.5,62,,37.2,percent of total Billed Charges,62% of total Billed Charges,46.5,62,,37.2,percent of total Billed Charges,62% of total Billed Charges,46.5,63.75,
97116 PT Gait Training Units,110331,CDM,420,RC,97116,HCPCS,Outpatient,,,75,52.5,GP,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,47.25,63,,37.8,percent of total Billed charges,63% of Total Billed Charges,46.5,62,,37.2,percent of total Billed Charges,62% of total BIlled charges,47.25,63,,37.8,percent of total Billed Charges,63% of total Billed Charges,63.75,85,,51,percent of total Billed Charges,85% of total Billed Charges,60,80,,48,percent of total Billed Charges,80% of total Billed Charges,46.5,62,,37.2,percent of total Billed Charges,62% of total Billed Charges,47.25,63,,37.8,percent of total Billed Charges,63% of total Billed Charges,46.5,62,,37.2,percent of total Billed Charges,62% of total Billed Charges,47.25,63,,37.8,percent of total billed charges,63% of total Billed Charges,46.5,62,,37.2,percent of total Billed Charges,62% of total Billed Charges,60,80,,48,percent of total Billed Charges,80% of Total Billed Charges,46.5,62,,37.2,percent of total Billed Charges,62% of total Billed Charges,46.5,62,,37.2,percent of total Billed Charges,62% of total Billed Charges,46.5,63.75,
"PT Hot, Cold Pack Assistant Units",110690,CDM,420,RC,97010,HCPCS,Outpatient,,,41,28.7,GP,32.8,80,,26.24,percent of total Billed Charges,80% of Total Billed Charges,25.83,63,,20.664,percent of total Billed charges,63% of Total Billed Charges,25.42,62,,20.336,percent of total Billed Charges,62% of total BIlled charges,25.83,63,,20.664,percent of total Billed Charges,63% of total Billed Charges,34.85,85,,27.88,percent of total Billed Charges,85% of total Billed Charges,32.8,80,,26.24,percent of total Billed Charges,80% of total Billed Charges,25.42,62,,20.336,percent of total Billed Charges,62% of total Billed Charges,25.83,63,,20.664,percent of total Billed Charges,63% of total Billed Charges,25.42,62,,20.336,percent of total Billed Charges,62% of total Billed Charges,25.83,63,,20.664,percent of total billed charges,63% of total Billed Charges,25.42,62,,20.336,percent of total Billed Charges,62% of total Billed Charges,32.8,80,,26.24,percent of total Billed Charges,80% of Total Billed Charges,25.42,62,,20.336,percent of total Billed Charges,62% of total Billed Charges,25.42,62,,20.336,percent of total Billed Charges,62% of total Billed Charges,25.42,34.85,
PT Iontophoresis Assistant Units,110691,CDM,420,RC,97033,HCPCS,Outpatient,,,71,49.7,GP,56.8,80,,45.44,percent of total Billed Charges,80% of Total Billed Charges,44.73,63,,35.784,percent of total Billed charges,63% of Total Billed Charges,44.02,62,,35.216,percent of total Billed Charges,62% of total BIlled charges,44.73,63,,35.784,percent of total Billed Charges,63% of total Billed Charges,60.35,85,,48.28,percent of total Billed Charges,85% of total Billed Charges,56.8,80,,45.44,percent of total Billed Charges,80% of total Billed Charges,44.02,62,,35.216,percent of total Billed Charges,62% of total Billed Charges,44.73,63,,35.784,percent of total Billed Charges,63% of total Billed Charges,44.02,62,,35.216,percent of total Billed Charges,62% of total Billed Charges,44.73,63,,35.784,percent of total billed charges,63% of total Billed Charges,44.02,62,,35.216,percent of total Billed Charges,62% of total Billed Charges,56.8,80,,45.44,percent of total Billed Charges,80% of Total Billed Charges,44.02,62,,35.216,percent of total Billed Charges,62% of total Billed Charges,44.02,62,,35.216,percent of total Billed Charges,62% of total Billed Charges,44.02,60.35,
97033 PT Iontophoresis Units,110691,CDM,420,RC,97033,HCPCS,Outpatient,,,71,49.7,GP,56.8,80,,45.44,percent of total Billed Charges,80% of Total Billed Charges,44.73,63,,35.784,percent of total Billed charges,63% of Total Billed Charges,44.02,62,,35.216,percent of total Billed Charges,62% of total BIlled charges,44.73,63,,35.784,percent of total Billed Charges,63% of total Billed Charges,60.35,85,,48.28,percent of total Billed Charges,85% of total Billed Charges,56.8,80,,45.44,percent of total Billed Charges,80% of total Billed Charges,44.02,62,,35.216,percent of total Billed Charges,62% of total Billed Charges,44.73,63,,35.784,percent of total Billed Charges,63% of total Billed Charges,44.02,62,,35.216,percent of total Billed Charges,62% of total Billed Charges,44.73,63,,35.784,percent of total billed charges,63% of total Billed Charges,44.02,62,,35.216,percent of total Billed Charges,62% of total Billed Charges,56.8,80,,45.44,percent of total Billed Charges,80% of Total Billed Charges,44.02,62,,35.216,percent of total Billed Charges,62% of total Billed Charges,44.02,62,,35.216,percent of total Billed Charges,62% of total Billed Charges,44.02,60.35,
PT Manual Therapy Assistant Units,110257,CDM,420,RC,97140,HCPCS,Outpatient,,,97,67.9,GP,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,61.11,63,,48.888,percent of total Billed charges,63% of Total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total BIlled charges,61.11,63,,48.888,percent of total Billed Charges,63% of total Billed Charges,82.45,85,,65.96,percent of total Billed Charges,85% of total Billed Charges,77.6,80,,62.08,percent of total Billed Charges,80% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,61.11,63,,48.888,percent of total Billed Charges,63% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,61.11,63,,48.888,percent of total billed charges,63% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,60.14,82.45,
97140 - PT Manual Therapy Units,110257,CDM,420,RC,97140,HCPCS,Outpatient,,,97,67.9,GP,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,61.11,63,,48.888,percent of total Billed charges,63% of Total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total BIlled charges,61.11,63,,48.888,percent of total Billed Charges,63% of total Billed Charges,82.45,85,,65.96,percent of total Billed Charges,85% of total Billed Charges,77.6,80,,62.08,percent of total Billed Charges,80% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,61.11,63,,48.888,percent of total Billed Charges,63% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,61.11,63,,48.888,percent of total billed charges,63% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,60.14,82.45,
PT Massage Assistant Units,110398,CDM,420,RC,97124,HCPCS,Outpatient,,,99,69.3,GP,79.2,80,,63.36,percent of total Billed Charges,80% of Total Billed Charges,62.37,63,,49.896,percent of total Billed charges,63% of Total Billed Charges,61.38,62,,49.104,percent of total Billed Charges,62% of total BIlled charges,62.37,63,,49.896,percent of total Billed Charges,63% of total Billed Charges,84.15,85,,67.32,percent of total Billed Charges,85% of total Billed Charges,79.2,80,,63.36,percent of total Billed Charges,80% of total Billed Charges,61.38,62,,49.104,percent of total Billed Charges,62% of total Billed Charges,62.37,63,,49.896,percent of total Billed Charges,63% of total Billed Charges,61.38,62,,49.104,percent of total Billed Charges,62% of total Billed Charges,62.37,63,,49.896,percent of total billed charges,63% of total Billed Charges,61.38,62,,49.104,percent of total Billed Charges,62% of total Billed Charges,79.2,80,,63.36,percent of total Billed Charges,80% of Total Billed Charges,61.38,62,,49.104,percent of total Billed Charges,62% of total Billed Charges,61.38,62,,49.104,percent of total Billed Charges,62% of total Billed Charges,61.38,84.15,
97124 - PT Massage Units,110398,CDM,420,RC,97124,HCPCS,Outpatient,,,99,69.3,GP,79.2,80,,63.36,percent of total Billed Charges,80% of Total Billed Charges,62.37,63,,49.896,percent of total Billed charges,63% of Total Billed Charges,61.38,62,,49.104,percent of total Billed Charges,62% of total BIlled charges,62.37,63,,49.896,percent of total Billed Charges,63% of total Billed Charges,84.15,85,,67.32,percent of total Billed Charges,85% of total Billed Charges,79.2,80,,63.36,percent of total Billed Charges,80% of total Billed Charges,61.38,62,,49.104,percent of total Billed Charges,62% of total Billed Charges,62.37,63,,49.896,percent of total Billed Charges,63% of total Billed Charges,61.38,62,,49.104,percent of total Billed Charges,62% of total Billed Charges,62.37,63,,49.896,percent of total billed charges,63% of total Billed Charges,61.38,62,,49.104,percent of total Billed Charges,62% of total Billed Charges,79.2,80,,63.36,percent of total Billed Charges,80% of Total Billed Charges,61.38,62,,49.104,percent of total Billed Charges,62% of total Billed Charges,61.38,62,,49.104,percent of total Billed Charges,62% of total Billed Charges,61.38,84.15,
PT Mechanical Traction Assistant Units,110497,CDM,420,RC,97012,HCPCS,Outpatient,,,52,36.4,GP,41.6,80,,33.28,percent of total Billed Charges,80% of Total Billed Charges,32.76,63,,26.208,percent of total Billed charges,63% of Total Billed Charges,32.24,62,,25.792,percent of total Billed Charges,62% of total BIlled charges,32.76,63,,26.208,percent of total Billed Charges,63% of total Billed Charges,44.2,85,,35.36,percent of total Billed Charges,85% of total Billed Charges,41.6,80,,33.28,percent of total Billed Charges,80% of total Billed Charges,32.24,62,,25.792,percent of total Billed Charges,62% of total Billed Charges,32.76,63,,26.208,percent of total Billed Charges,63% of total Billed Charges,32.24,62,,25.792,percent of total Billed Charges,62% of total Billed Charges,32.76,63,,26.208,percent of total billed charges,63% of total Billed Charges,32.24,62,,25.792,percent of total Billed Charges,62% of total Billed Charges,41.6,80,,33.28,percent of total Billed Charges,80% of Total Billed Charges,32.24,62,,25.792,percent of total Billed Charges,62% of total Billed Charges,32.24,62,,25.792,percent of total Billed Charges,62% of total Billed Charges,32.24,44.2,
97012 - PT Mechanical Traction Units,110497,CDM,420,RC,97012,HCPCS,Outpatient,,,52,36.4,GP,41.6,80,,33.28,percent of total Billed Charges,80% of Total Billed Charges,32.76,63,,26.208,percent of total Billed charges,63% of Total Billed Charges,32.24,62,,25.792,percent of total Billed Charges,62% of total BIlled charges,32.76,63,,26.208,percent of total Billed Charges,63% of total Billed Charges,44.2,85,,35.36,percent of total Billed Charges,85% of total Billed Charges,41.6,80,,33.28,percent of total Billed Charges,80% of total Billed Charges,32.24,62,,25.792,percent of total Billed Charges,62% of total Billed Charges,32.76,63,,26.208,percent of total Billed Charges,63% of total Billed Charges,32.24,62,,25.792,percent of total Billed Charges,62% of total Billed Charges,32.76,63,,26.208,percent of total billed charges,63% of total Billed Charges,32.24,62,,25.792,percent of total Billed Charges,62% of total Billed Charges,41.6,80,,33.28,percent of total Billed Charges,80% of Total Billed Charges,32.24,62,,25.792,percent of total Billed Charges,62% of total Billed Charges,32.24,62,,25.792,percent of total Billed Charges,62% of total Billed Charges,32.24,44.2,
PT Neuromuscular Reeducation Assist Unit,110232,CDM,420,RC,97112,HCPCS,Outpatient,,,120,84,GP,96,80,,76.8,percent of total Billed Charges,80% of Total Billed Charges,75.6,63,,60.48,percent of total Billed charges,63% of Total Billed Charges,74.4,62,,59.52,percent of total Billed Charges,62% of total BIlled charges,75.6,63,,60.48,percent of total Billed Charges,63% of total Billed Charges,102,85,,81.6,percent of total Billed Charges,85% of total Billed Charges,96,80,,76.8,percent of total Billed Charges,80% of total Billed Charges,74.4,62,,59.52,percent of total Billed Charges,62% of total Billed Charges,75.6,63,,60.48,percent of total Billed Charges,63% of total Billed Charges,74.4,62,,59.52,percent of total Billed Charges,62% of total Billed Charges,75.6,63,,60.48,percent of total billed charges,63% of total Billed Charges,74.4,62,,59.52,percent of total Billed Charges,62% of total Billed Charges,96,80,,76.8,percent of total Billed Charges,80% of Total Billed Charges,74.4,62,,59.52,percent of total Billed Charges,62% of total Billed Charges,74.4,62,,59.52,percent of total Billed Charges,62% of total Billed Charges,74.4,102,
97112 PT Neuromuscular Reeducation Units,110232,CDM,420,RC,97112,HCPCS,Outpatient,,,120,84,GP,96,80,,76.8,percent of total Billed Charges,80% of Total Billed Charges,75.6,63,,60.48,percent of total Billed charges,63% of Total Billed Charges,74.4,62,,59.52,percent of total Billed Charges,62% of total BIlled charges,75.6,63,,60.48,percent of total Billed Charges,63% of total Billed Charges,102,85,,81.6,percent of total Billed Charges,85% of total Billed Charges,96,80,,76.8,percent of total Billed Charges,80% of total Billed Charges,74.4,62,,59.52,percent of total Billed Charges,62% of total Billed Charges,75.6,63,,60.48,percent of total Billed Charges,63% of total Billed Charges,74.4,62,,59.52,percent of total Billed Charges,62% of total Billed Charges,75.6,63,,60.48,percent of total billed charges,63% of total Billed Charges,74.4,62,,59.52,percent of total Billed Charges,62% of total Billed Charges,96,80,,76.8,percent of total Billed Charges,80% of Total Billed Charges,74.4,62,,59.52,percent of total Billed Charges,62% of total Billed Charges,74.4,62,,59.52,percent of total Billed Charges,62% of total Billed Charges,74.4,102,
PT Orthotic Mgmt Train Assistant Units,110125,CDM,420,RC,97760,HCPCS,Outpatient,,,165,115.5,GP,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,103.95,63,,83.16,percent of total Billed charges,63% of Total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total BIlled charges,103.95,63,,83.16,percent of total Billed Charges,63% of total Billed Charges,140.25,85,,112.2,percent of total Billed Charges,85% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,103.95,63,,83.16,percent of total Billed Charges,63% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,103.95,63,,83.16,percent of total billed charges,63% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,102.3,140.25,
97760 - PT Orthotic Management Train Units,110125,CDM,420,RC,97760,HCPCS,Outpatient,,,165,115.5,GP,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,103.95,63,,83.16,percent of total Billed charges,63% of Total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total BIlled charges,103.95,63,,83.16,percent of total Billed Charges,63% of total Billed Charges,140.25,85,,112.2,percent of total Billed Charges,85% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,103.95,63,,83.16,percent of total Billed Charges,63% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,103.95,63,,83.16,percent of total billed charges,63% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,102.3,140.25,
PT Orthotic/Prost MgmtTrain Assist Unit,111038,CDM,420,RC,97761,HCPCS,Outpatient,,,138,96.6,GP,110.4,80,,88.32,percent of total Billed Charges,80% of Total Billed Charges,86.94,63,,69.552,percent of total Billed charges,63% of Total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total BIlled charges,86.94,63,,69.552,percent of total Billed Charges,63% of total Billed Charges,117.3,85,,93.84,percent of total Billed Charges,85% of total Billed Charges,110.4,80,,88.32,percent of total Billed Charges,80% of total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total Billed Charges,86.94,63,,69.552,percent of total Billed Charges,63% of total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total Billed Charges,86.94,63,,69.552,percent of total billed charges,63% of total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total Billed Charges,110.4,80,,88.32,percent of total Billed Charges,80% of Total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total Billed Charges,85.56,117.3,
"PT Orthotic/Prosthetic Manage,Train Units",111039,CDM,420,RC,97763,HCPCS,Outpatient,,,189,132.3,GP,151.2,80,,120.96,percent of total Billed Charges,80% of Total Billed Charges,119.07,63,,95.256,percent of total Billed charges,63% of Total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total BIlled charges,119.07,63,,95.256,percent of total Billed Charges,63% of total Billed Charges,160.65,85,,128.52,percent of total Billed Charges,85% of total Billed Charges,151.2,80,,120.96,percent of total Billed Charges,80% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,119.07,63,,95.256,percent of total Billed Charges,63% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,119.07,63,,95.256,percent of total billed charges,63% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,151.2,80,,120.96,percent of total Billed Charges,80% of Total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,117.18,160.65,
PT Paraffin Assistant Units,110693,CDM,420,RC,97018,HCPCS,Outpatient,,,21,14.7,GP,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.23,63,,10.584,percent of total Billed charges,63% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total BIlled charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,17.85,85,,14.28,percent of total Billed Charges,85% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total billed charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,17.85,
Medical procedures,110693,CDM,420,RC,97018,HCPCS,Outpatient,,,21,14.7,GP,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.23,63,,10.584,percent of total Billed charges,63% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total BIlled charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,17.85,85,,14.28,percent of total Billed Charges,85% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total billed charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,17.85,
97761 PT PROSTHETIC TRAINING INITIAL ENCOUNTER CHARGE,111038,CDM,420,RC,97761,HCPCS,Outpatient,,,138,96.6,GP,110.4,80,,88.32,percent of total Billed Charges,80% of Total Billed Charges,86.94,63,,69.552,percent of total Billed charges,63% of Total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total BIlled charges,86.94,63,,69.552,percent of total Billed Charges,63% of total Billed Charges,117.3,85,,93.84,percent of total Billed Charges,85% of total Billed Charges,110.4,80,,88.32,percent of total Billed Charges,80% of total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total Billed Charges,86.94,63,,69.552,percent of total Billed Charges,63% of total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total Billed Charges,86.94,63,,69.552,percent of total billed charges,63% of total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total Billed Charges,110.4,80,,88.32,percent of total Billed Charges,80% of Total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total Billed Charges,85.56,117.3,
"PT Prosthetic Management, Train Assistant Units",111039,CDM,420,RC,97763,HCPCS,Outpatient,,,189,132.3,GP,151.2,80,,120.96,percent of total Billed Charges,80% of Total Billed Charges,119.07,63,,95.256,percent of total Billed charges,63% of Total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total BIlled charges,119.07,63,,95.256,percent of total Billed Charges,63% of total Billed Charges,160.65,85,,128.52,percent of total Billed Charges,85% of total Billed Charges,151.2,80,,120.96,percent of total Billed Charges,80% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,119.07,63,,95.256,percent of total Billed Charges,63% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,119.07,63,,95.256,percent of total billed charges,63% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,151.2,80,,120.96,percent of total Billed Charges,80% of Total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,117.18,160.65,
PT ROM Measure Extremity Trunk No Hands Assistant Units,110273,CDM,420,RC,95851,HCPCS,Outpatient,,,72,50.4,GP,57.6,80,,46.08,percent of total Billed Charges,80% of Total Billed Charges,45.36,63,,36.288,percent of total Billed charges,63% of Total Billed Charges,44.64,62,,35.712,percent of total Billed Charges,62% of total BIlled charges,45.36,63,,36.288,percent of total Billed Charges,63% of total Billed Charges,61.2,85,,48.96,percent of total Billed Charges,85% of total Billed Charges,57.6,80,,46.08,percent of total Billed Charges,80% of total Billed Charges,44.64,62,,35.712,percent of total Billed Charges,62% of total Billed Charges,45.36,63,,36.288,percent of total Billed Charges,63% of total Billed Charges,44.64,62,,35.712,percent of total Billed Charges,62% of total Billed Charges,45.36,63,,36.288,percent of total billed charges,63% of total Billed Charges,44.64,62,,35.712,percent of total Billed Charges,62% of total Billed Charges,57.6,80,,46.08,percent of total Billed Charges,80% of Total Billed Charges,44.64,62,,35.712,percent of total Billed Charges,62% of total Billed Charges,44.64,62,,35.712,percent of total Billed Charges,62% of total Billed Charges,44.64,61.2,
PT Therapeutic Activity Assistant Units,110281,CDM,420,RC,97530,HCPCS,Outpatient,,,133,93.1,GP,106.4,80,,85.12,percent of total Billed Charges,80% of Total Billed Charges,83.79,63,,67.032,percent of total Billed charges,63% of Total Billed Charges,82.46,62,,65.968,percent of total Billed Charges,62% of total BIlled charges,83.79,63,,67.032,percent of total Billed Charges,63% of total Billed Charges,113.05,85,,90.44,percent of total Billed Charges,85% of total Billed Charges,106.4,80,,85.12,percent of total Billed Charges,80% of total Billed Charges,82.46,62,,65.968,percent of total Billed Charges,62% of total Billed Charges,83.79,63,,67.032,percent of total Billed Charges,63% of total Billed Charges,82.46,62,,65.968,percent of total Billed Charges,62% of total Billed Charges,83.79,63,,67.032,percent of total billed charges,63% of total Billed Charges,82.46,62,,65.968,percent of total Billed Charges,62% of total Billed Charges,106.4,80,,85.12,percent of total Billed Charges,80% of Total Billed Charges,82.46,62,,65.968,percent of total Billed Charges,62% of total Billed Charges,82.46,62,,65.968,percent of total Billed Charges,62% of total Billed Charges,82.46,113.05,
97530 PT Therapeutic Activity Units,110281,CDM,420,RC,97530,HCPCS,Outpatient,,,133,93.1,GP,106.4,80,,85.12,percent of total Billed Charges,80% of Total Billed Charges,83.79,63,,67.032,percent of total Billed charges,63% of Total Billed Charges,82.46,62,,65.968,percent of total Billed Charges,62% of total BIlled charges,83.79,63,,67.032,percent of total Billed Charges,63% of total Billed Charges,113.05,85,,90.44,percent of total Billed Charges,85% of total Billed Charges,106.4,80,,85.12,percent of total Billed Charges,80% of total Billed Charges,82.46,62,,65.968,percent of total Billed Charges,62% of total Billed Charges,83.79,63,,67.032,percent of total Billed Charges,63% of total Billed Charges,82.46,62,,65.968,percent of total Billed Charges,62% of total Billed Charges,83.79,63,,67.032,percent of total billed charges,63% of total Billed Charges,82.46,62,,65.968,percent of total Billed Charges,62% of total Billed Charges,106.4,80,,85.12,percent of total Billed Charges,80% of Total Billed Charges,82.46,62,,65.968,percent of total Billed Charges,62% of total Billed Charges,82.46,62,,65.968,percent of total Billed Charges,62% of total Billed Charges,82.46,113.05,
PT Therapeutic Exercise Assistant Units,110612,CDM,420,RC,97110,HCPCS,Outpatient,,,86,60.2,GP,68.8,80,,55.04,percent of total Billed Charges,80% of Total Billed Charges,54.18,63,,43.344,percent of total Billed charges,63% of Total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total BIlled charges,54.18,63,,43.344,percent of total Billed Charges,63% of total Billed Charges,73.1,85,,58.48,percent of total Billed Charges,85% of total Billed Charges,68.8,80,,55.04,percent of total Billed Charges,80% of total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total Billed Charges,54.18,63,,43.344,percent of total Billed Charges,63% of total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total Billed Charges,54.18,63,,43.344,percent of total billed charges,63% of total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total Billed Charges,68.8,80,,55.04,percent of total Billed Charges,80% of Total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total Billed Charges,53.32,73.1,
97110 - PT Therapeutic Exercise Units,110612,CDM,420,RC,97110,HCPCS,Outpatient,,,86,60.2,GP,68.8,80,,55.04,percent of total Billed Charges,80% of Total Billed Charges,54.18,63,,43.344,percent of total Billed charges,63% of Total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total BIlled charges,54.18,63,,43.344,percent of total Billed Charges,63% of total Billed Charges,73.1,85,,58.48,percent of total Billed Charges,85% of total Billed Charges,68.8,80,,55.04,percent of total Billed Charges,80% of total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total Billed Charges,54.18,63,,43.344,percent of total Billed Charges,63% of total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total Billed Charges,54.18,63,,43.344,percent of total billed charges,63% of total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total Billed Charges,68.8,80,,55.04,percent of total Billed Charges,80% of Total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total Billed Charges,53.32,73.1,
PT Ultrasound Assistant Units,110547,CDM,420,RC,97035,HCPCS,Outpatient,,,50,35,GP,40,80,,32,percent of total Billed Charges,80% of Total Billed Charges,31.5,63,,25.2,percent of total Billed charges,63% of Total Billed Charges,31,62,,24.8,percent of total Billed Charges,62% of total BIlled charges,31.5,63,,25.2,percent of total Billed Charges,63% of total Billed Charges,42.5,85,,34,percent of total Billed Charges,85% of total Billed Charges,40,80,,32,percent of total Billed Charges,80% of total Billed Charges,31,62,,24.8,percent of total Billed Charges,62% of total Billed Charges,31.5,63,,25.2,percent of total Billed Charges,63% of total Billed Charges,31,62,,24.8,percent of total Billed Charges,62% of total Billed Charges,31.5,63,,25.2,percent of total billed charges,63% of total Billed Charges,31,62,,24.8,percent of total Billed Charges,62% of total Billed Charges,40,80,,32,percent of total Billed Charges,80% of Total Billed Charges,31,62,,24.8,percent of total Billed Charges,62% of total Billed Charges,31,62,,24.8,percent of total Billed Charges,62% of total Billed Charges,31,42.5,
97035 - PT Ultrasound Units,110547,CDM,420,RC,97035,HCPCS,Outpatient,,,50,35,GP,40,80,,32,percent of total Billed Charges,80% of Total Billed Charges,31.5,63,,25.2,percent of total Billed charges,63% of Total Billed Charges,31,62,,24.8,percent of total Billed Charges,62% of total BIlled charges,31.5,63,,25.2,percent of total Billed Charges,63% of total Billed Charges,42.5,85,,34,percent of total Billed Charges,85% of total Billed Charges,40,80,,32,percent of total Billed Charges,80% of total Billed Charges,31,62,,24.8,percent of total Billed Charges,62% of total Billed Charges,31.5,63,,25.2,percent of total Billed Charges,63% of total Billed Charges,31,62,,24.8,percent of total Billed Charges,62% of total Billed Charges,31.5,63,,25.2,percent of total billed charges,63% of total Billed Charges,31,62,,24.8,percent of total Billed Charges,62% of total Billed Charges,40,80,,32,percent of total Billed Charges,80% of Total Billed Charges,31,62,,24.8,percent of total Billed Charges,62% of total Billed Charges,31,62,,24.8,percent of total Billed Charges,62% of total Billed Charges,31,42.5,
PT Wheelchair Management Assistant Units,111037,CDM,420,RC,97542,HCPCS,Outpatient,,,107,74.9,GP,85.6,80,,68.48,percent of total Billed Charges,80% of Total Billed Charges,67.41,63,,53.928,percent of total Billed charges,63% of Total Billed Charges,66.34,62,,53.072,percent of total Billed Charges,62% of total BIlled charges,67.41,63,,53.928,percent of total Billed Charges,63% of total Billed Charges,90.95,85,,72.76,percent of total Billed Charges,85% of total Billed Charges,85.6,80,,68.48,percent of total Billed Charges,80% of total Billed Charges,66.34,62,,53.072,percent of total Billed Charges,62% of total Billed Charges,67.41,63,,53.928,percent of total Billed Charges,63% of total Billed Charges,66.34,62,,53.072,percent of total Billed Charges,62% of total Billed Charges,67.41,63,,53.928,percent of total billed charges,63% of total Billed Charges,66.34,62,,53.072,percent of total Billed Charges,62% of total Billed Charges,85.6,80,,68.48,percent of total Billed Charges,80% of Total Billed Charges,66.34,62,,53.072,percent of total Billed Charges,62% of total Billed Charges,66.34,62,,53.072,percent of total Billed Charges,62% of total Billed Charges,66.34,90.95,
97542 PT WHEELCHAIR MGT PROPULSION TRAINING CHARGE,111037,CDM,420,RC,97542,HCPCS,Outpatient,,,107,74.9,GP,85.6,80,,68.48,percent of total Billed Charges,80% of Total Billed Charges,67.41,63,,53.928,percent of total Billed charges,63% of Total Billed Charges,66.34,62,,53.072,percent of total Billed Charges,62% of total BIlled charges,67.41,63,,53.928,percent of total Billed Charges,63% of total Billed Charges,90.95,85,,72.76,percent of total Billed Charges,85% of total Billed Charges,85.6,80,,68.48,percent of total Billed Charges,80% of total Billed Charges,66.34,62,,53.072,percent of total Billed Charges,62% of total Billed Charges,67.41,63,,53.928,percent of total Billed Charges,63% of total Billed Charges,66.34,62,,53.072,percent of total Billed Charges,62% of total Billed Charges,67.41,63,,53.928,percent of total billed charges,63% of total Billed Charges,66.34,62,,53.072,percent of total Billed Charges,62% of total Billed Charges,85.6,80,,68.48,percent of total Billed Charges,80% of Total Billed Charges,66.34,62,,53.072,percent of total Billed Charges,62% of total Billed Charges,66.34,62,,53.072,percent of total Billed Charges,62% of total Billed Charges,66.34,90.95,
97163 - PT Evaluation Units High Complexity,111020,CDM,424,RC,97163,HCPCS,Outpatient,,,291,203.7,GP,232.8,80,,186.24,percent of total Billed Charges,80% of Total Billed Charges,183.33,63,,146.664,percent of total Billed charges,63% of Total Billed Charges,180.42,62,,144.336,percent of total Billed Charges,62% of total BIlled charges,183.33,63,,146.664,percent of total Billed Charges,63% of total Billed Charges,247.35,85,,197.88,percent of total Billed Charges,85% of total Billed Charges,232.8,80,,186.24,percent of total Billed Charges,80% of total Billed Charges,180.42,62,,144.336,percent of total Billed Charges,62% of total Billed Charges,183.33,63,,146.664,percent of total Billed Charges,63% of total Billed Charges,180.42,62,,144.336,percent of total Billed Charges,62% of total Billed Charges,183.33,63,,146.664,percent of total billed charges,63% of total Billed Charges,180.42,62,,144.336,percent of total Billed Charges,62% of total Billed Charges,232.8,80,,186.24,percent of total Billed Charges,80% of Total Billed Charges,180.42,62,,144.336,percent of total Billed Charges,62% of total Billed Charges,180.42,62,,144.336,percent of total Billed Charges,62% of total Billed Charges,180.42,247.35,
97161 - PT Evaluation Units Low Complexity,111018,CDM,424,RC,97161,HCPCS,Outpatient,,,291,203.7,GP,232.8,80,,186.24,percent of total Billed Charges,80% of Total Billed Charges,183.33,63,,146.664,percent of total Billed charges,63% of Total Billed Charges,180.42,62,,144.336,percent of total Billed Charges,62% of total BIlled charges,183.33,63,,146.664,percent of total Billed Charges,63% of total Billed Charges,247.35,85,,197.88,percent of total Billed Charges,85% of total Billed Charges,232.8,80,,186.24,percent of total Billed Charges,80% of total Billed Charges,180.42,62,,144.336,percent of total Billed Charges,62% of total Billed Charges,183.33,63,,146.664,percent of total Billed Charges,63% of total Billed Charges,180.42,62,,144.336,percent of total Billed Charges,62% of total Billed Charges,183.33,63,,146.664,percent of total billed charges,63% of total Billed Charges,180.42,62,,144.336,percent of total Billed Charges,62% of total Billed Charges,232.8,80,,186.24,percent of total Billed Charges,80% of Total Billed Charges,180.42,62,,144.336,percent of total Billed Charges,62% of total Billed Charges,180.42,62,,144.336,percent of total Billed Charges,62% of total Billed Charges,180.42,247.35,
97162 - PT Evaluation Units Moderate Complexity,111019,CDM,424,RC,97162,HCPCS,Outpatient,,,291,203.7,GP,232.8,80,,186.24,percent of total Billed Charges,80% of Total Billed Charges,183.33,63,,146.664,percent of total Billed charges,63% of Total Billed Charges,180.42,62,,144.336,percent of total Billed Charges,62% of total BIlled charges,183.33,63,,146.664,percent of total Billed Charges,63% of total Billed Charges,247.35,85,,197.88,percent of total Billed Charges,85% of total Billed Charges,232.8,80,,186.24,percent of total Billed Charges,80% of total Billed Charges,180.42,62,,144.336,percent of total Billed Charges,62% of total Billed Charges,183.33,63,,146.664,percent of total Billed Charges,63% of total Billed Charges,180.42,62,,144.336,percent of total Billed Charges,62% of total Billed Charges,183.33,63,,146.664,percent of total billed charges,63% of total Billed Charges,180.42,62,,144.336,percent of total Billed Charges,62% of total Billed Charges,232.8,80,,186.24,percent of total Billed Charges,80% of Total Billed Charges,180.42,62,,144.336,percent of total Billed Charges,62% of total Billed Charges,180.42,62,,144.336,percent of total Billed Charges,62% of total Billed Charges,180.42,247.35,
97164 - PT Re-Evaluation Units 97164,110694,CDM,424,RC,97164,HCPCS,Outpatient,,,199,139.3,GP,159.2,80,,127.36,percent of total Billed Charges,80% of Total Billed Charges,125.37,63,,100.296,percent of total Billed charges,63% of Total Billed Charges,123.38,62,,98.704,percent of total Billed Charges,62% of total BIlled charges,125.37,63,,100.296,percent of total Billed Charges,63% of total Billed Charges,169.15,85,,135.32,percent of total Billed Charges,85% of total Billed Charges,159.2,80,,127.36,percent of total Billed Charges,80% of total Billed Charges,123.38,62,,98.704,percent of total Billed Charges,62% of total Billed Charges,125.37,63,,100.296,percent of total Billed Charges,63% of total Billed Charges,123.38,62,,98.704,percent of total Billed Charges,62% of total Billed Charges,125.37,63,,100.296,percent of total billed charges,63% of total Billed Charges,123.38,62,,98.704,percent of total Billed Charges,62% of total Billed Charges,159.2,80,,127.36,percent of total Billed Charges,80% of Total Billed Charges,123.38,62,,98.704,percent of total Billed Charges,62% of total Billed Charges,123.38,62,,98.704,percent of total Billed Charges,62% of total Billed Charges,123.38,169.15,
OT Attended E-Stim Assistant Units,500017,CDM,430,RC,97032,HCPCS,Outpatient,,,51,35.7,GO,40.8,80,,32.64,percent of total Billed Charges,80% of Total Billed Charges,32.13,63,,25.704,percent of total Billed charges,63% of Total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total BIlled charges,32.13,63,,25.704,percent of total Billed Charges,63% of total Billed Charges,43.35,85,,34.68,percent of total Billed Charges,85% of total Billed Charges,40.8,80,,32.64,percent of total Billed Charges,80% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,32.13,63,,25.704,percent of total Billed Charges,63% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,32.13,63,,25.704,percent of total billed charges,63% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,40.8,80,,32.64,percent of total Billed Charges,80% of Total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,31.62,43.35,
97032 - OT Attended E-Stim Units,500017,CDM,430,RC,97032,HCPCS,Outpatient,,,51,35.7,GO,40.8,80,,32.64,percent of total Billed Charges,80% of Total Billed Charges,32.13,63,,25.704,percent of total Billed charges,63% of Total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total BIlled charges,32.13,63,,25.704,percent of total Billed Charges,63% of total Billed Charges,43.35,85,,34.68,percent of total Billed Charges,85% of total Billed Charges,40.8,80,,32.64,percent of total Billed Charges,80% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,32.13,63,,25.704,percent of total Billed Charges,63% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,32.13,63,,25.704,percent of total billed charges,63% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,40.8,80,,32.64,percent of total Billed Charges,80% of Total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,31.62,43.35,
OT Iontophoresis Assistant Units,500039,CDM,430,RC,97033,HCPCS,Outpatient,,,84,58.8,GO,67.2,80,,53.76,percent of total Billed Charges,80% of Total Billed Charges,52.92,63,,42.336,percent of total Billed charges,63% of Total Billed Charges,52.08,62,,41.664,percent of total Billed Charges,62% of total BIlled charges,52.92,63,,42.336,percent of total Billed Charges,63% of total Billed Charges,71.4,85,,57.12,percent of total Billed Charges,85% of total Billed Charges,67.2,80,,53.76,percent of total Billed Charges,80% of total Billed Charges,52.08,62,,41.664,percent of total Billed Charges,62% of total Billed Charges,52.92,63,,42.336,percent of total Billed Charges,63% of total Billed Charges,52.08,62,,41.664,percent of total Billed Charges,62% of total Billed Charges,52.92,63,,42.336,percent of total billed charges,63% of total Billed Charges,52.08,62,,41.664,percent of total Billed Charges,62% of total Billed Charges,67.2,80,,53.76,percent of total Billed Charges,80% of Total Billed Charges,52.08,62,,41.664,percent of total Billed Charges,62% of total Billed Charges,52.08,62,,41.664,percent of total Billed Charges,62% of total Billed Charges,52.08,71.4,
97033 - OT Iontophoresis Units,500039,CDM,430,RC,97033,HCPCS,Outpatient,,,84,58.8,GO,67.2,80,,53.76,percent of total Billed Charges,80% of Total Billed Charges,52.92,63,,42.336,percent of total Billed charges,63% of Total Billed Charges,52.08,62,,41.664,percent of total Billed Charges,62% of total BIlled charges,52.92,63,,42.336,percent of total Billed Charges,63% of total Billed Charges,71.4,85,,57.12,percent of total Billed Charges,85% of total Billed Charges,67.2,80,,53.76,percent of total Billed Charges,80% of total Billed Charges,52.08,62,,41.664,percent of total Billed Charges,62% of total Billed Charges,52.92,63,,42.336,percent of total Billed Charges,63% of total Billed Charges,52.08,62,,41.664,percent of total Billed Charges,62% of total Billed Charges,52.92,63,,42.336,percent of total billed charges,63% of total Billed Charges,52.08,62,,41.664,percent of total Billed Charges,62% of total Billed Charges,67.2,80,,53.76,percent of total Billed Charges,80% of Total Billed Charges,52.08,62,,41.664,percent of total Billed Charges,62% of total Billed Charges,52.08,62,,41.664,percent of total Billed Charges,62% of total Billed Charges,52.08,71.4,
OT Manual Therapy Assistant Units,500012,CDM,430,RC,97140,HCPCS,Outpatient,,,80,56,GO,64,80,,51.2,percent of total Billed Charges,80% of Total Billed Charges,50.4,63,,40.32,percent of total Billed charges,63% of Total Billed Charges,49.6,62,,39.68,percent of total Billed Charges,62% of total BIlled charges,50.4,63,,40.32,percent of total Billed Charges,63% of total Billed Charges,68,85,,54.4,percent of total Billed Charges,85% of total Billed Charges,64,80,,51.2,percent of total Billed Charges,80% of total Billed Charges,49.6,62,,39.68,percent of total Billed Charges,62% of total Billed Charges,50.4,63,,40.32,percent of total Billed Charges,63% of total Billed Charges,49.6,62,,39.68,percent of total Billed Charges,62% of total Billed Charges,50.4,63,,40.32,percent of total billed charges,63% of total Billed Charges,49.6,62,,39.68,percent of total Billed Charges,62% of total Billed Charges,64,80,,51.2,percent of total Billed Charges,80% of Total Billed Charges,49.6,62,,39.68,percent of total Billed Charges,62% of total Billed Charges,49.6,62,,39.68,percent of total Billed Charges,62% of total Billed Charges,49.6,68,
97140 - OT Manual Therapy Units,500012,CDM,430,RC,97140,HCPCS,Outpatient,,,80,56,GO,64,80,,51.2,percent of total Billed Charges,80% of Total Billed Charges,50.4,63,,40.32,percent of total Billed charges,63% of Total Billed Charges,49.6,62,,39.68,percent of total Billed Charges,62% of total BIlled charges,50.4,63,,40.32,percent of total Billed Charges,63% of total Billed Charges,68,85,,54.4,percent of total Billed Charges,85% of total Billed Charges,64,80,,51.2,percent of total Billed Charges,80% of total Billed Charges,49.6,62,,39.68,percent of total Billed Charges,62% of total Billed Charges,50.4,63,,40.32,percent of total Billed Charges,63% of total Billed Charges,49.6,62,,39.68,percent of total Billed Charges,62% of total Billed Charges,50.4,63,,40.32,percent of total billed charges,63% of total Billed Charges,49.6,62,,39.68,percent of total Billed Charges,62% of total Billed Charges,64,80,,51.2,percent of total Billed Charges,80% of Total Billed Charges,49.6,62,,39.68,percent of total Billed Charges,62% of total Billed Charges,49.6,62,,39.68,percent of total Billed Charges,62% of total Billed Charges,49.6,68,
OT Massage Assistant Units,500020,CDM,430,RC,97124,HCPCS,Outpatient,,,70,49,GO,56,80,,44.8,percent of total Billed Charges,80% of Total Billed Charges,44.1,63,,35.28,percent of total Billed charges,63% of Total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total BIlled charges,44.1,63,,35.28,percent of total Billed Charges,63% of total Billed Charges,59.5,85,,47.6,percent of total Billed Charges,85% of total Billed Charges,56,80,,44.8,percent of total Billed Charges,80% of total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total Billed Charges,44.1,63,,35.28,percent of total Billed Charges,63% of total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total Billed Charges,44.1,63,,35.28,percent of total billed charges,63% of total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total Billed Charges,56,80,,44.8,percent of total Billed Charges,80% of Total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total Billed Charges,43.4,59.5,
97124 - OT Massage Units,500020,CDM,430,RC,97124,HCPCS,Outpatient,,,70,49,GO,56,80,,44.8,percent of total Billed Charges,80% of Total Billed Charges,44.1,63,,35.28,percent of total Billed charges,63% of Total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total BIlled charges,44.1,63,,35.28,percent of total Billed Charges,63% of total Billed Charges,59.5,85,,47.6,percent of total Billed Charges,85% of total Billed Charges,56,80,,44.8,percent of total Billed Charges,80% of total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total Billed Charges,44.1,63,,35.28,percent of total Billed Charges,63% of total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total Billed Charges,44.1,63,,35.28,percent of total billed charges,63% of total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total Billed Charges,56,80,,44.8,percent of total Billed Charges,80% of Total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total Billed Charges,43.4,59.5,
OT Neuromuscular Reeducation Assistant Units,500010,CDM,430,RC,97112,HCPCS,Outpatient,,,89,62.3,GO,71.2,80,,56.96,percent of total Billed Charges,80% of Total Billed Charges,56.07,63,,44.856,percent of total Billed charges,63% of Total Billed Charges,55.18,62,,44.144,percent of total Billed Charges,62% of total BIlled charges,56.07,63,,44.856,percent of total Billed Charges,63% of total Billed Charges,75.65,85,,60.52,percent of total Billed Charges,85% of total Billed Charges,71.2,80,,56.96,percent of total Billed Charges,80% of total Billed Charges,55.18,62,,44.144,percent of total Billed Charges,62% of total Billed Charges,56.07,63,,44.856,percent of total Billed Charges,63% of total Billed Charges,55.18,62,,44.144,percent of total Billed Charges,62% of total Billed Charges,56.07,63,,44.856,percent of total billed charges,63% of total Billed Charges,55.18,62,,44.144,percent of total Billed Charges,62% of total Billed Charges,71.2,80,,56.96,percent of total Billed Charges,80% of Total Billed Charges,55.18,62,,44.144,percent of total Billed Charges,62% of total Billed Charges,55.18,62,,44.144,percent of total Billed Charges,62% of total Billed Charges,55.18,75.65,
97112 - OT Neuromuscular Reeducation Units,500010,CDM,430,RC,97112,HCPCS,Outpatient,,,89,62.3,GO,71.2,80,,56.96,percent of total Billed Charges,80% of Total Billed Charges,56.07,63,,44.856,percent of total Billed charges,63% of Total Billed Charges,55.18,62,,44.144,percent of total Billed Charges,62% of total BIlled charges,56.07,63,,44.856,percent of total Billed Charges,63% of total Billed Charges,75.65,85,,60.52,percent of total Billed Charges,85% of total Billed Charges,71.2,80,,56.96,percent of total Billed Charges,80% of total Billed Charges,55.18,62,,44.144,percent of total Billed Charges,62% of total Billed Charges,56.07,63,,44.856,percent of total Billed Charges,63% of total Billed Charges,55.18,62,,44.144,percent of total Billed Charges,62% of total Billed Charges,56.07,63,,44.856,percent of total billed charges,63% of total Billed Charges,55.18,62,,44.144,percent of total Billed Charges,62% of total Billed Charges,71.2,80,,56.96,percent of total Billed Charges,80% of Total Billed Charges,55.18,62,,44.144,percent of total Billed Charges,62% of total Billed Charges,55.18,62,,44.144,percent of total Billed Charges,62% of total Billed Charges,55.18,75.65,
"OT Orthotic Management, Train Assistant Units",500069,CDM,430,RC,97763,HCPCS,Outpatient,,,189,132.3,GO,151.2,80,,120.96,percent of total Billed Charges,80% of Total Billed Charges,119.07,63,,95.256,percent of total Billed charges,63% of Total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total BIlled charges,119.07,63,,95.256,percent of total Billed Charges,63% of total Billed Charges,160.65,85,,128.52,percent of total Billed Charges,85% of total Billed Charges,151.2,80,,120.96,percent of total Billed Charges,80% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,119.07,63,,95.256,percent of total Billed Charges,63% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,119.07,63,,95.256,percent of total billed charges,63% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,151.2,80,,120.96,percent of total Billed Charges,80% of Total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,117.18,160.65,
Initial orthotic management and training,97760,CDM,430,RC,97760,HCPCS,Outpatient,,,165,115.5,GO,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,103.95,63,,83.16,percent of total Billed charges,63% of Total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total BIlled charges,103.95,63,,83.16,percent of total Billed Charges,63% of total Billed Charges,140.25,85,,112.2,percent of total Billed Charges,85% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,103.95,63,,83.16,percent of total Billed Charges,63% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,103.95,63,,83.16,percent of total billed charges,63% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,102.3,140.25,
OT Orthotic/Prosthetic ManageTrain Assistant Units,97760,CDM,430,RC,97760,HCPCS,Outpatient,,,165,115.5,GO,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,103.95,63,,83.16,percent of total Billed charges,63% of Total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total BIlled charges,103.95,63,,83.16,percent of total Billed Charges,63% of total Billed Charges,140.25,85,,112.2,percent of total Billed Charges,85% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,103.95,63,,83.16,percent of total Billed Charges,63% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,103.95,63,,83.16,percent of total billed charges,63% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,102.3,140.25,
"OT Orthotic/Prosthetic Manage,Train Units",500069,CDM,430,RC,97763,HCPCS,Outpatient,,,189,132.3,GO,151.2,80,,120.96,percent of total Billed Charges,80% of Total Billed Charges,119.07,63,,95.256,percent of total Billed charges,63% of Total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total BIlled charges,119.07,63,,95.256,percent of total Billed Charges,63% of total Billed Charges,160.65,85,,128.52,percent of total Billed Charges,85% of total Billed Charges,151.2,80,,120.96,percent of total Billed Charges,80% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,119.07,63,,95.256,percent of total Billed Charges,63% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,119.07,63,,95.256,percent of total billed charges,63% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,151.2,80,,120.96,percent of total Billed Charges,80% of Total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,117.18,160.65,
OT Orthotic/Prosthetic Management/Training Unit,500069,CDM,430,RC,97763,HCPCS,Outpatient,,,189,132.3,GO,151.2,80,,120.96,percent of total Billed Charges,80% of Total Billed Charges,119.07,63,,95.256,percent of total Billed charges,63% of Total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total BIlled charges,119.07,63,,95.256,percent of total Billed Charges,63% of total Billed Charges,160.65,85,,128.52,percent of total Billed Charges,85% of total Billed Charges,151.2,80,,120.96,percent of total Billed Charges,80% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,119.07,63,,95.256,percent of total Billed Charges,63% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,119.07,63,,95.256,percent of total billed charges,63% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,151.2,80,,120.96,percent of total Billed Charges,80% of Total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,117.18,62,,93.744,percent of total Billed Charges,62% of total Billed Charges,117.18,160.65,
OT Paraffin Bath Assistant Units,500025,CDM,430,RC,97018,HCPCS,Outpatient,,,30,21,GO,24,80,,19.2,percent of total Billed Charges,80% of Total Billed Charges,18.9,63,,15.12,percent of total Billed charges,63% of Total Billed Charges,18.6,62,,14.88,percent of total Billed Charges,62% of total BIlled charges,18.9,63,,15.12,percent of total Billed Charges,63% of total Billed Charges,25.5,85,,20.4,percent of total Billed Charges,85% of total Billed Charges,24,80,,19.2,percent of total Billed Charges,80% of total Billed Charges,18.6,62,,14.88,percent of total Billed Charges,62% of total Billed Charges,18.9,63,,15.12,percent of total Billed Charges,63% of total Billed Charges,18.6,62,,14.88,percent of total Billed Charges,62% of total Billed Charges,18.9,63,,15.12,percent of total billed charges,63% of total Billed Charges,18.6,62,,14.88,percent of total Billed Charges,62% of total Billed Charges,24,80,,19.2,percent of total Billed Charges,80% of Total Billed Charges,18.6,62,,14.88,percent of total Billed Charges,62% of total Billed Charges,18.6,62,,14.88,percent of total Billed Charges,62% of total Billed Charges,18.6,25.5,
97018 - OT Paraffin Bath Units,97018,CDM,430,RC,97018,HCPCS,Outpatient,,,30,21,GO,24,80,,19.2,percent of total Billed Charges,80% of Total Billed Charges,18.9,63,,15.12,percent of total Billed charges,63% of Total Billed Charges,18.6,62,,14.88,percent of total Billed Charges,62% of total BIlled charges,18.9,63,,15.12,percent of total Billed Charges,63% of total Billed Charges,25.5,85,,20.4,percent of total Billed Charges,85% of total Billed Charges,24,80,,19.2,percent of total Billed Charges,80% of total Billed Charges,18.6,62,,14.88,percent of total Billed Charges,62% of total Billed Charges,18.9,63,,15.12,percent of total Billed Charges,63% of total Billed Charges,18.6,62,,14.88,percent of total Billed Charges,62% of total Billed Charges,18.9,63,,15.12,percent of total billed charges,63% of total Billed Charges,18.6,62,,14.88,percent of total Billed Charges,62% of total Billed Charges,24,80,,19.2,percent of total Billed Charges,80% of Total Billed Charges,18.6,62,,14.88,percent of total Billed Charges,62% of total Billed Charges,18.6,62,,14.88,percent of total Billed Charges,62% of total Billed Charges,18.6,25.5,
"OT Prosthetic Management, Train Assistant Units",500068,CDM,430,RC,97761,HCPCS,Outpatient,,,138,96.6,GO,110.4,80,,88.32,percent of total Billed Charges,80% of Total Billed Charges,86.94,63,,69.552,percent of total Billed charges,63% of Total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total BIlled charges,86.94,63,,69.552,percent of total Billed Charges,63% of total Billed Charges,117.3,85,,93.84,percent of total Billed Charges,85% of total Billed Charges,110.4,80,,88.32,percent of total Billed Charges,80% of total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total Billed Charges,86.94,63,,69.552,percent of total Billed Charges,63% of total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total Billed Charges,86.94,63,,69.552,percent of total billed charges,63% of total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total Billed Charges,110.4,80,,88.32,percent of total Billed Charges,80% of Total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total Billed Charges,85.56,117.3,
97535 - OT Self Care Home Management Units,500002,CDM,430,RC,97535,HCPCS,Outpatient,,,93,65.1,GO,74.4,80,,59.52,percent of total Billed Charges,80% of Total Billed Charges,58.59,63,,46.872,percent of total Billed charges,63% of Total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total BIlled charges,58.59,63,,46.872,percent of total Billed Charges,63% of total Billed Charges,79.05,85,,63.24,percent of total Billed Charges,85% of total Billed Charges,74.4,80,,59.52,percent of total Billed Charges,80% of total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,58.59,63,,46.872,percent of total Billed Charges,63% of total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,58.59,63,,46.872,percent of total billed charges,63% of total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,74.4,80,,59.52,percent of total Billed Charges,80% of Total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,57.66,79.05,
OT Self Care Home Mgmt Assistant Units,500002,CDM,430,RC,97535,HCPCS,Outpatient,,,93,65.1,GO,74.4,80,,59.52,percent of total Billed Charges,80% of Total Billed Charges,58.59,63,,46.872,percent of total Billed charges,63% of Total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total BIlled charges,58.59,63,,46.872,percent of total Billed Charges,63% of total Billed Charges,79.05,85,,63.24,percent of total Billed Charges,85% of total Billed Charges,74.4,80,,59.52,percent of total Billed Charges,80% of total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,58.59,63,,46.872,percent of total Billed Charges,63% of total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,58.59,63,,46.872,percent of total billed charges,63% of total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,74.4,80,,59.52,percent of total Billed Charges,80% of Total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,57.66,79.05,
OT Therapeutic Activities Assistant Units,500004,CDM,430,RC,97530,HCPCS,Outpatient,,,93,65.1,GO,74.4,80,,59.52,percent of total Billed Charges,80% of Total Billed Charges,58.59,63,,46.872,percent of total Billed charges,63% of Total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total BIlled charges,58.59,63,,46.872,percent of total Billed Charges,63% of total Billed Charges,79.05,85,,63.24,percent of total Billed Charges,85% of total Billed Charges,74.4,80,,59.52,percent of total Billed Charges,80% of total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,58.59,63,,46.872,percent of total Billed Charges,63% of total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,58.59,63,,46.872,percent of total billed charges,63% of total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,74.4,80,,59.52,percent of total Billed Charges,80% of Total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,57.66,79.05,
97530 - OT Therapeutic Activities Units,500004,CDM,430,RC,97530,HCPCS,Outpatient,,,93,65.1,GO,74.4,80,,59.52,percent of total Billed Charges,80% of Total Billed Charges,58.59,63,,46.872,percent of total Billed charges,63% of Total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total BIlled charges,58.59,63,,46.872,percent of total Billed Charges,63% of total Billed Charges,79.05,85,,63.24,percent of total Billed Charges,85% of total Billed Charges,74.4,80,,59.52,percent of total Billed Charges,80% of total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,58.59,63,,46.872,percent of total Billed Charges,63% of total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,58.59,63,,46.872,percent of total billed charges,63% of total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,74.4,80,,59.52,percent of total Billed Charges,80% of Total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,57.66,62,,46.128,percent of total Billed Charges,62% of total Billed Charges,57.66,79.05,
OT Therapeutic Exercise Assistant Units,500027,CDM,430,RC,97110,HCPCS,Outpatient,,,86,60.2,GO,68.8,80,,55.04,percent of total Billed Charges,80% of Total Billed Charges,54.18,63,,43.344,percent of total Billed charges,63% of Total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total BIlled charges,54.18,63,,43.344,percent of total Billed Charges,63% of total Billed Charges,73.1,85,,58.48,percent of total Billed Charges,85% of total Billed Charges,68.8,80,,55.04,percent of total Billed Charges,80% of total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total Billed Charges,54.18,63,,43.344,percent of total Billed Charges,63% of total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total Billed Charges,54.18,63,,43.344,percent of total billed charges,63% of total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total Billed Charges,68.8,80,,55.04,percent of total Billed Charges,80% of Total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total Billed Charges,53.32,73.1,
97110 - OT Therapeutic Exercise Units,500027,CDM,430,RC,97110,HCPCS,Outpatient,,,86,60.2,GO,68.8,80,,55.04,percent of total Billed Charges,80% of Total Billed Charges,54.18,63,,43.344,percent of total Billed charges,63% of Total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total BIlled charges,54.18,63,,43.344,percent of total Billed Charges,63% of total Billed Charges,73.1,85,,58.48,percent of total Billed Charges,85% of total Billed Charges,68.8,80,,55.04,percent of total Billed Charges,80% of total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total Billed Charges,54.18,63,,43.344,percent of total Billed Charges,63% of total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total Billed Charges,54.18,63,,43.344,percent of total billed charges,63% of total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total Billed Charges,68.8,80,,55.04,percent of total Billed Charges,80% of Total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total Billed Charges,53.32,62,,42.656,percent of total Billed Charges,62% of total Billed Charges,53.32,73.1,
OT Ultrasound Assistant Units,500003,CDM,430,RC,97035,HCPCS,Outpatient,,,35,24.5,GO,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,22.05,63,,17.64,percent of total Billed charges,63% of Total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total BIlled charges,22.05,63,,17.64,percent of total Billed Charges,63% of total Billed Charges,29.75,85,,23.8,percent of total Billed Charges,85% of total Billed Charges,28,80,,22.4,percent of total Billed Charges,80% of total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total Billed Charges,22.05,63,,17.64,percent of total Billed Charges,63% of total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total Billed Charges,22.05,63,,17.64,percent of total billed charges,63% of total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total Billed Charges,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total Billed Charges,21.7,29.75,
97035 - OT Ultrasound Units,500003,CDM,430,RC,97035,HCPCS,Outpatient,,,35,24.5,GO,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,22.05,63,,17.64,percent of total Billed charges,63% of Total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total BIlled charges,22.05,63,,17.64,percent of total Billed Charges,63% of total Billed Charges,29.75,85,,23.8,percent of total Billed Charges,85% of total Billed Charges,28,80,,22.4,percent of total Billed Charges,80% of total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total Billed Charges,22.05,63,,17.64,percent of total Billed Charges,63% of total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total Billed Charges,22.05,63,,17.64,percent of total billed charges,63% of total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total Billed Charges,28,80,,22.4,percent of total Billed Charges,80% of Total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total Billed Charges,21.7,62,,17.36,percent of total Billed Charges,62% of total Billed Charges,21.7,29.75,
OT Wheelchair Management Assistant Units,500035,CDM,430,RC,97542,HCPCS,Outpatient,,,82,57.4,GO,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,51.66,63,,41.328,percent of total Billed charges,63% of Total Billed Charges,50.84,62,,40.672,percent of total Billed Charges,62% of total BIlled charges,51.66,63,,41.328,percent of total Billed Charges,63% of total Billed Charges,69.7,85,,55.76,percent of total Billed Charges,85% of total Billed Charges,65.6,80,,52.48,percent of total Billed Charges,80% of total Billed Charges,50.84,62,,40.672,percent of total Billed Charges,62% of total Billed Charges,51.66,63,,41.328,percent of total Billed Charges,63% of total Billed Charges,50.84,62,,40.672,percent of total Billed Charges,62% of total Billed Charges,51.66,63,,41.328,percent of total billed charges,63% of total Billed Charges,50.84,62,,40.672,percent of total Billed Charges,62% of total Billed Charges,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,50.84,62,,40.672,percent of total Billed Charges,62% of total Billed Charges,50.84,62,,40.672,percent of total Billed Charges,62% of total Billed Charges,50.84,69.7,
97542 - OT Wheelchair Management Units,500035,CDM,430,RC,97542,HCPCS,Outpatient,,,82,57.4,GO,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,51.66,63,,41.328,percent of total Billed charges,63% of Total Billed Charges,50.84,62,,40.672,percent of total Billed Charges,62% of total BIlled charges,51.66,63,,41.328,percent of total Billed Charges,63% of total Billed Charges,69.7,85,,55.76,percent of total Billed Charges,85% of total Billed Charges,65.6,80,,52.48,percent of total Billed Charges,80% of total Billed Charges,50.84,62,,40.672,percent of total Billed Charges,62% of total Billed Charges,51.66,63,,41.328,percent of total Billed Charges,63% of total Billed Charges,50.84,62,,40.672,percent of total Billed Charges,62% of total Billed Charges,51.66,63,,41.328,percent of total billed charges,63% of total Billed Charges,50.84,62,,40.672,percent of total Billed Charges,62% of total Billed Charges,65.6,80,,52.48,percent of total Billed Charges,80% of Total Billed Charges,50.84,62,,40.672,percent of total Billed Charges,62% of total Billed Charges,50.84,62,,40.672,percent of total Billed Charges,62% of total Billed Charges,50.84,69.7,
97167 - OT Evaluation Units High Complexity,500043,CDM,434,RC,97167,HCPCS,Outpatient,,,281,196.7,,224.8,80,,179.84,percent of total Billed Charges,80% of Total Billed Charges,177.03,63,,141.624,percent of total Billed charges,63% of Total Billed Charges,174.22,62,,139.376,percent of total Billed Charges,62% of total BIlled charges,177.03,63,,141.624,percent of total Billed Charges,63% of total Billed Charges,238.85,85,,191.08,percent of total Billed Charges,85% of total Billed Charges,224.8,80,,179.84,percent of total Billed Charges,80% of total Billed Charges,174.22,62,,139.376,percent of total Billed Charges,62% of total Billed Charges,177.03,63,,141.624,percent of total Billed Charges,63% of total Billed Charges,174.22,62,,139.376,percent of total Billed Charges,62% of total Billed Charges,177.03,63,,141.624,percent of total billed charges,63% of total Billed Charges,174.22,62,,139.376,percent of total Billed Charges,62% of total Billed Charges,224.8,80,,179.84,percent of total Billed Charges,80% of Total Billed Charges,174.22,62,,139.376,percent of total Billed Charges,62% of total Billed Charges,174.22,62,,139.376,percent of total Billed Charges,62% of total Billed Charges,174.22,238.85,
97165 - OT Evaluation Units Low Complexity,500041,CDM,434,RC,97165,HCPCS,Outpatient,,,230,161,,184,80,,147.2,percent of total Billed Charges,80% of Total Billed Charges,144.9,63,,115.92,percent of total Billed charges,63% of Total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total BIlled charges,144.9,63,,115.92,percent of total Billed Charges,63% of total Billed Charges,195.5,85,,156.4,percent of total Billed Charges,85% of total Billed Charges,184,80,,147.2,percent of total Billed Charges,80% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,144.9,63,,115.92,percent of total Billed Charges,63% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,144.9,63,,115.92,percent of total billed charges,63% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,184,80,,147.2,percent of total Billed Charges,80% of Total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,142.6,62,,114.08,percent of total Billed Charges,62% of total Billed Charges,142.6,195.5,
97166 - OT Evaluation Units Moderate Complexity,500042,CDM,434,RC,97166,HCPCS,Outpatient,,,255,178.5,,204,80,,163.2,percent of total Billed Charges,80% of Total Billed Charges,160.65,63,,128.52,percent of total Billed charges,63% of Total Billed Charges,158.1,62,,126.48,percent of total Billed Charges,62% of total BIlled charges,160.65,63,,128.52,percent of total Billed Charges,63% of total Billed Charges,216.75,85,,173.4,percent of total Billed Charges,85% of total Billed Charges,204,80,,163.2,percent of total Billed Charges,80% of total Billed Charges,158.1,62,,126.48,percent of total Billed Charges,62% of total Billed Charges,160.65,63,,128.52,percent of total Billed Charges,63% of total Billed Charges,158.1,62,,126.48,percent of total Billed Charges,62% of total Billed Charges,160.65,63,,128.52,percent of total billed charges,63% of total Billed Charges,158.1,62,,126.48,percent of total Billed Charges,62% of total Billed Charges,204,80,,163.2,percent of total Billed Charges,80% of Total Billed Charges,158.1,62,,126.48,percent of total Billed Charges,62% of total Billed Charges,158.1,62,,126.48,percent of total Billed Charges,62% of total Billed Charges,158.1,216.75,
92524 - Behavioral Qualitative Analysis Units,410057,CDM,440,RC,92524,HCPCS,Outpatient,,,320,224,,256,80,,204.8,percent of total Billed Charges,80% of Total Billed Charges,201.6,63,,161.28,percent of total Billed charges,63% of Total Billed Charges,198.4,62,,158.72,percent of total Billed Charges,62% of total BIlled charges,201.6,63,,161.28,percent of total Billed Charges,63% of total Billed Charges,272,85,,217.6,percent of total Billed Charges,85% of total Billed Charges,256,80,,204.8,percent of total Billed Charges,80% of total Billed Charges,198.4,62,,158.72,percent of total Billed Charges,62% of total Billed Charges,201.6,63,,161.28,percent of total Billed Charges,63% of total Billed Charges,198.4,62,,158.72,percent of total Billed Charges,62% of total Billed Charges,201.6,63,,161.28,percent of total billed charges,63% of total Billed Charges,198.4,62,,158.72,percent of total Billed Charges,62% of total Billed Charges,256,80,,204.8,percent of total Billed Charges,80% of Total Billed Charges,198.4,62,,158.72,percent of total Billed Charges,62% of total Billed Charges,198.4,62,,158.72,percent of total Billed Charges,62% of total Billed Charges,198.4,272,
92507 - SLP Auditory Processing Tx Units,410004,CDM,440,RC,92507,HCPCS,Outpatient,,,183,128.1,,146.4,80,,117.12,percent of total Billed Charges,80% of Total Billed Charges,115.29,63,,92.232,percent of total Billed charges,63% of Total Billed Charges,113.46,62,,90.768,percent of total Billed Charges,62% of total BIlled charges,115.29,63,,92.232,percent of total Billed Charges,63% of total Billed Charges,155.55,85,,124.44,percent of total Billed Charges,85% of total Billed Charges,146.4,80,,117.12,percent of total Billed Charges,80% of total Billed Charges,113.46,62,,90.768,percent of total Billed Charges,62% of total Billed Charges,115.29,63,,92.232,percent of total Billed Charges,63% of total Billed Charges,113.46,62,,90.768,percent of total Billed Charges,62% of total Billed Charges,115.29,63,,92.232,percent of total billed charges,63% of total Billed Charges,113.46,62,,90.768,percent of total Billed Charges,62% of total Billed Charges,146.4,80,,117.12,percent of total Billed Charges,80% of Total Billed Charges,113.46,62,,90.768,percent of total Billed Charges,62% of total Billed Charges,113.46,62,,90.768,percent of total Billed Charges,62% of total Billed Charges,113.46,155.55,
97130 - SLP Cog Ther Intervent Addl 15Min Units,410060,CDM,440,RC,97130,HCPCS,Outpatient,,,66,46.2,,52.8,80,,42.24,percent of total Billed Charges,80% of Total Billed Charges,41.58,63,,33.264,percent of total Billed charges,63% of Total Billed Charges,40.92,62,,32.736,percent of total Billed Charges,62% of total BIlled charges,41.58,63,,33.264,percent of total Billed Charges,63% of total Billed Charges,56.1,85,,44.88,percent of total Billed Charges,85% of total Billed Charges,52.8,80,,42.24,percent of total Billed Charges,80% of total Billed Charges,40.92,62,,32.736,percent of total Billed Charges,62% of total Billed Charges,41.58,63,,33.264,percent of total Billed Charges,63% of total Billed Charges,40.92,62,,32.736,percent of total Billed Charges,62% of total Billed Charges,41.58,63,,33.264,percent of total billed charges,63% of total Billed Charges,40.92,62,,32.736,percent of total Billed Charges,62% of total Billed Charges,52.8,80,,42.24,percent of total Billed Charges,80% of Total Billed Charges,40.92,62,,32.736,percent of total Billed Charges,62% of total Billed Charges,40.92,62,,32.736,percent of total Billed Charges,62% of total Billed Charges,40.92,56.1,
97129 - SLP Cog Ther Intervent First 15Min Units,410059,CDM,440,RC,97129,HCPCS,Outpatient,,,69,48.3,,55.2,80,,44.16,percent of total Billed Charges,80% of Total Billed Charges,43.47,63,,34.776,percent of total Billed charges,63% of Total Billed Charges,42.78,62,,34.224,percent of total Billed Charges,62% of total BIlled charges,43.47,63,,34.776,percent of total Billed Charges,63% of total Billed Charges,58.65,85,,46.92,percent of total Billed Charges,85% of total Billed Charges,55.2,80,,44.16,percent of total Billed Charges,80% of total Billed Charges,42.78,62,,34.224,percent of total Billed Charges,62% of total Billed Charges,43.47,63,,34.776,percent of total Billed Charges,63% of total Billed Charges,42.78,62,,34.224,percent of total Billed Charges,62% of total Billed Charges,43.47,63,,34.776,percent of total billed charges,63% of total Billed Charges,42.78,62,,34.224,percent of total Billed Charges,62% of total Billed Charges,55.2,80,,44.16,percent of total Billed Charges,80% of Total Billed Charges,42.78,62,,34.224,percent of total Billed Charges,62% of total Billed Charges,42.78,62,,34.224,percent of total Billed Charges,62% of total Billed Charges,42.78,58.65,
92526 - SLP Swallow Dysfunction Oral Feed Units,410021,CDM,440,RC,92526,HCPCS,Outpatient,,,199,139.3,,159.2,80,,127.36,percent of total Billed Charges,80% of Total Billed Charges,125.37,63,,100.296,percent of total Billed charges,63% of Total Billed Charges,123.38,62,,98.704,percent of total Billed Charges,62% of total BIlled charges,125.37,63,,100.296,percent of total Billed Charges,63% of total Billed Charges,169.15,85,,135.32,percent of total Billed Charges,85% of total Billed Charges,159.2,80,,127.36,percent of total Billed Charges,80% of total Billed Charges,123.38,62,,98.704,percent of total Billed Charges,62% of total Billed Charges,125.37,63,,100.296,percent of total Billed Charges,63% of total Billed Charges,123.38,62,,98.704,percent of total Billed Charges,62% of total Billed Charges,125.37,63,,100.296,percent of total billed charges,63% of total Billed Charges,123.38,62,,98.704,percent of total Billed Charges,62% of total Billed Charges,159.2,80,,127.36,percent of total Billed Charges,80% of Total Billed Charges,123.38,62,,98.704,percent of total Billed Charges,62% of total Billed Charges,123.38,62,,98.704,percent of total Billed Charges,62% of total Billed Charges,123.38,169.15,
92609 - SLP Tx Generating Device Units,410062,CDM,440,RC,92609,HCPCS,Outpatient,,,301,210.7,,240.8,80,,192.64,percent of total Billed Charges,80% of Total Billed Charges,189.63,63,,151.704,percent of total Billed charges,63% of Total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total BIlled charges,189.63,63,,151.704,percent of total Billed Charges,63% of total Billed Charges,255.85,85,,204.68,percent of total Billed Charges,85% of total Billed Charges,240.8,80,,192.64,percent of total Billed Charges,80% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,189.63,63,,151.704,percent of total Billed Charges,63% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,189.63,63,,151.704,percent of total billed charges,63% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,240.8,80,,192.64,percent of total Billed Charges,80% of Total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,186.62,255.85,
96125 - SLP Standard Cog Performance Test Units,410058,CDM,440,RC,96125,HCPCS,Outpatient,,,305,213.5,,244,80,,195.2,percent of total Billed Charges,80% of Total Billed Charges,192.15,63,,153.72,percent of total Billed charges,63% of Total Billed Charges,189.1,62,,151.28,percent of total Billed Charges,62% of total BIlled charges,192.15,63,,153.72,percent of total Billed Charges,63% of total Billed Charges,259.25,85,,207.4,percent of total Billed Charges,85% of total Billed Charges,244,80,,195.2,percent of total Billed Charges,80% of total Billed Charges,189.1,62,,151.28,percent of total Billed Charges,62% of total Billed Charges,192.15,63,,153.72,percent of total Billed Charges,63% of total Billed Charges,189.1,62,,151.28,percent of total Billed Charges,62% of total Billed Charges,192.15,63,,153.72,percent of total billed charges,63% of total Billed Charges,189.1,62,,151.28,percent of total Billed Charges,62% of total Billed Charges,244,80,,195.2,percent of total Billed Charges,80% of Total Billed Charges,189.1,62,,151.28,percent of total Billed Charges,62% of total Billed Charges,189.1,62,,151.28,percent of total Billed Charges,62% of total Billed Charges,189.1,259.25,
97530 - SP TH THER ACT 1 ON1/15MN,410010,CDM,440,RC,97530,HCPCS,Outpatient,,,80,56,,64,80,,51.2,percent of total Billed Charges,80% of Total Billed Charges,50.4,63,,40.32,percent of total Billed charges,63% of Total Billed Charges,49.6,62,,39.68,percent of total Billed Charges,62% of total BIlled charges,50.4,63,,40.32,percent of total Billed Charges,63% of total Billed Charges,68,85,,54.4,percent of total Billed Charges,85% of total Billed Charges,64,80,,51.2,percent of total Billed Charges,80% of total Billed Charges,49.6,62,,39.68,percent of total Billed Charges,62% of total Billed Charges,50.4,63,,40.32,percent of total Billed Charges,63% of total Billed Charges,49.6,62,,39.68,percent of total Billed Charges,62% of total Billed Charges,50.4,63,,40.32,percent of total billed charges,63% of total Billed Charges,49.6,62,,39.68,percent of total Billed Charges,62% of total Billed Charges,64,80,,51.2,percent of total Billed Charges,80% of Total Billed Charges,49.6,62,,39.68,percent of total Billed Charges,62% of total Billed Charges,49.6,62,,39.68,percent of total Billed Charges,62% of total Billed Charges,49.6,68,
97110 - SP TH THER PROC EX/15MIN,410009,CDM,440,RC,97110,HCPCS,Outpatient,,,73,51.1,,58.4,80,,46.72,percent of total Billed Charges,80% of Total Billed Charges,45.99,63,,36.792,percent of total Billed charges,63% of Total Billed Charges,45.26,62,,36.208,percent of total Billed Charges,62% of total BIlled charges,45.99,63,,36.792,percent of total Billed Charges,63% of total Billed Charges,62.05,85,,49.64,percent of total Billed Charges,85% of total Billed Charges,58.4,80,,46.72,percent of total Billed Charges,80% of total Billed Charges,45.26,62,,36.208,percent of total Billed Charges,62% of total Billed Charges,45.99,63,,36.792,percent of total Billed Charges,63% of total Billed Charges,45.26,62,,36.208,percent of total Billed Charges,62% of total Billed Charges,45.99,63,,36.792,percent of total billed charges,63% of total Billed Charges,45.26,62,,36.208,percent of total Billed Charges,62% of total Billed Charges,58.4,80,,46.72,percent of total Billed Charges,80% of Total Billed Charges,45.26,62,,36.208,percent of total Billed Charges,62% of total Billed Charges,45.26,62,,36.208,percent of total Billed Charges,62% of total Billed Charges,45.26,62.05,
96105 - SLP Assessment of Aphasia Units,410014,CDM,444,RC,96105,HCPCS,Outpatient,,,232,162.4,,185.6,80,,148.48,percent of total Billed Charges,80% of Total Billed Charges,146.16,63,,116.928,percent of total Billed charges,63% of Total Billed Charges,143.84,62,,115.072,percent of total Billed Charges,62% of total BIlled charges,146.16,63,,116.928,percent of total Billed Charges,63% of total Billed Charges,197.2,85,,157.76,percent of total Billed Charges,85% of total Billed Charges,185.6,80,,148.48,percent of total Billed Charges,80% of total Billed Charges,143.84,62,,115.072,percent of total Billed Charges,62% of total Billed Charges,146.16,63,,116.928,percent of total Billed Charges,63% of total Billed Charges,143.84,62,,115.072,percent of total Billed Charges,62% of total Billed Charges,146.16,63,,116.928,percent of total billed charges,63% of total Billed Charges,143.84,62,,115.072,percent of total Billed Charges,62% of total Billed Charges,185.6,80,,148.48,percent of total Billed Charges,80% of Total Billed Charges,143.84,62,,115.072,percent of total Billed Charges,62% of total Billed Charges,143.84,62,,115.072,percent of total Billed Charges,62% of total Billed Charges,143.84,197.2,
92523 - SLP Eval Lang ComprehensionExpress Unit,410051,CDM,444,RC,92523,HCPCS,Outpatient,,,284,198.8,,227.2,80,,181.76,percent of total Billed Charges,80% of Total Billed Charges,178.92,63,,143.136,percent of total Billed charges,63% of Total Billed Charges,176.08,62,,140.864,percent of total Billed Charges,62% of total BIlled charges,178.92,63,,143.136,percent of total Billed Charges,63% of total Billed Charges,241.4,85,,193.12,percent of total Billed Charges,85% of total Billed Charges,227.2,80,,181.76,percent of total Billed Charges,80% of total Billed Charges,176.08,62,,140.864,percent of total Billed Charges,62% of total Billed Charges,178.92,63,,143.136,percent of total Billed Charges,63% of total Billed Charges,176.08,62,,140.864,percent of total Billed Charges,62% of total Billed Charges,178.92,63,,143.136,percent of total billed charges,63% of total Billed Charges,176.08,62,,140.864,percent of total Billed Charges,62% of total Billed Charges,227.2,80,,181.76,percent of total Billed Charges,80% of Total Billed Charges,176.08,62,,140.864,percent of total Billed Charges,62% of total Billed Charges,176.08,62,,140.864,percent of total Billed Charges,62% of total Billed Charges,176.08,241.4,
92522 - SLP Eval of Speech Sound Prod Units,410018,CDM,444,RC,92522,HCPCS,Outpatient,,,148,103.6,,118.4,80,,94.72,percent of total Billed Charges,80% of Total Billed Charges,93.24,63,,74.592,percent of total Billed charges,63% of Total Billed Charges,91.76,62,,73.408,percent of total Billed Charges,62% of total BIlled charges,93.24,63,,74.592,percent of total Billed Charges,63% of total Billed Charges,125.8,85,,100.64,percent of total Billed Charges,85% of total Billed Charges,118.4,80,,94.72,percent of total Billed Charges,80% of total Billed Charges,91.76,62,,73.408,percent of total Billed Charges,62% of total Billed Charges,93.24,63,,74.592,percent of total Billed Charges,63% of total Billed Charges,91.76,62,,73.408,percent of total Billed Charges,62% of total Billed Charges,93.24,63,,74.592,percent of total billed charges,63% of total Billed Charges,91.76,62,,73.408,percent of total Billed Charges,62% of total Billed Charges,118.4,80,,94.72,percent of total Billed Charges,80% of Total Billed Charges,91.76,62,,73.408,percent of total Billed Charges,62% of total Billed Charges,91.76,62,,73.408,percent of total Billed Charges,62% of total Billed Charges,91.76,125.8,
92521 - SLP Evaluation of Speech Fluency Units,410056,CDM,444,RC,92521,HCPCS,Outpatient,,,390,273,,312,80,,249.6,percent of total Billed Charges,80% of Total Billed Charges,245.7,63,,196.56,percent of total Billed charges,63% of Total Billed Charges,241.8,62,,193.44,percent of total Billed Charges,62% of total BIlled charges,245.7,63,,196.56,percent of total Billed Charges,63% of total Billed Charges,331.5,85,,265.2,percent of total Billed Charges,85% of total Billed Charges,312,80,,249.6,percent of total Billed Charges,80% of total Billed Charges,241.8,62,,193.44,percent of total Billed Charges,62% of total Billed Charges,245.7,63,,196.56,percent of total Billed Charges,63% of total Billed Charges,241.8,62,,193.44,percent of total Billed Charges,62% of total Billed Charges,245.7,63,,196.56,percent of total billed charges,63% of total Billed Charges,241.8,62,,193.44,percent of total Billed Charges,62% of total Billed Charges,312,80,,249.6,percent of total Billed Charges,80% of Total Billed Charges,241.8,62,,193.44,percent of total Billed Charges,62% of total Billed Charges,241.8,62,,193.44,percent of total Billed Charges,62% of total Billed Charges,241.8,331.5,
SLP Fiberoptic Swallow Eval Units,410050,CDM,444,RC,92612,HCPCS,Outpatient,,,611,427.7,,488.8,80,,391.04,percent of total Billed Charges,80% of Total Billed Charges,384.93,63,,307.944,percent of total Billed charges,63% of Total Billed Charges,378.82,62,,303.056,percent of total Billed Charges,62% of total BIlled charges,384.93,63,,307.944,percent of total Billed Charges,63% of total Billed Charges,519.35,85,,415.48,percent of total Billed Charges,85% of total Billed Charges,488.8,80,,391.04,percent of total Billed Charges,80% of total Billed Charges,378.82,62,,303.056,percent of total Billed Charges,62% of total Billed Charges,384.93,63,,307.944,percent of total Billed Charges,63% of total Billed Charges,378.82,62,,303.056,percent of total Billed Charges,62% of total Billed Charges,384.93,63,,307.944,percent of total billed charges,63% of total Billed Charges,378.82,62,,303.056,percent of total Billed Charges,62% of total Billed Charges,488.8,80,,391.04,percent of total Billed Charges,80% of Total Billed Charges,378.82,62,,303.056,percent of total Billed Charges,62% of total Billed Charges,378.82,62,,303.056,percent of total Billed Charges,62% of total Billed Charges,378.82,519.35,
92610 - SLP Pharyngeal Swallow Eval Units,410020,CDM,444,RC,92610,HCPCS,Outpatient,,,167,116.9,,133.6,80,,106.88,percent of total Billed Charges,80% of Total Billed Charges,105.21,63,,84.168,percent of total Billed charges,63% of Total Billed Charges,103.54,62,,82.832,percent of total Billed Charges,62% of total BIlled charges,105.21,63,,84.168,percent of total Billed Charges,63% of total Billed Charges,141.95,85,,113.56,percent of total Billed Charges,85% of total Billed Charges,133.6,80,,106.88,percent of total Billed Charges,80% of total Billed Charges,103.54,62,,82.832,percent of total Billed Charges,62% of total Billed Charges,105.21,63,,84.168,percent of total Billed Charges,63% of total Billed Charges,103.54,62,,82.832,percent of total Billed Charges,62% of total Billed Charges,105.21,63,,84.168,percent of total billed charges,63% of total Billed Charges,103.54,62,,82.832,percent of total Billed Charges,62% of total Billed Charges,133.6,80,,106.88,percent of total Billed Charges,80% of Total Billed Charges,103.54,62,,82.832,percent of total Billed Charges,62% of total Billed Charges,103.54,62,,82.832,percent of total Billed Charges,62% of total Billed Charges,103.54,141.95,
92597 - SLP UseFit Speech Prosthetic Eval Units,410049,CDM,444,RC,92597,HCPCS,Outpatient,,,226,158.2,,180.8,80,,144.64,percent of total Billed Charges,80% of Total Billed Charges,142.38,63,,113.904,percent of total Billed charges,63% of Total Billed Charges,140.12,62,,112.096,percent of total Billed Charges,62% of total BIlled charges,142.38,63,,113.904,percent of total Billed Charges,63% of total Billed Charges,192.1,85,,153.68,percent of total Billed Charges,85% of total Billed Charges,180.8,80,,144.64,percent of total Billed Charges,80% of total Billed Charges,140.12,62,,112.096,percent of total Billed Charges,62% of total Billed Charges,142.38,63,,113.904,percent of total Billed Charges,63% of total Billed Charges,140.12,62,,112.096,percent of total Billed Charges,62% of total Billed Charges,142.38,63,,113.904,percent of total billed charges,63% of total Billed Charges,140.12,62,,112.096,percent of total Billed Charges,62% of total Billed Charges,180.8,80,,144.64,percent of total Billed Charges,80% of Total Billed Charges,140.12,62,,112.096,percent of total Billed Charges,62% of total Billed Charges,140.12,62,,112.096,percent of total Billed Charges,62% of total Billed Charges,140.12,192.1,
92612 - SLP FIBEROPTIC SWALLOW EVAL BY VIDEO CHARGE,410050,CDM,444,RC,92612,HCPCS,Outpatient,,,611,427.7,,488.8,80,,391.04,percent of total Billed Charges,80% of Total Billed Charges,384.93,63,,307.944,percent of total Billed charges,63% of Total Billed Charges,378.82,62,,303.056,percent of total Billed Charges,62% of total BIlled charges,384.93,63,,307.944,percent of total Billed Charges,63% of total Billed Charges,519.35,85,,415.48,percent of total Billed Charges,85% of total Billed Charges,488.8,80,,391.04,percent of total Billed Charges,80% of total Billed Charges,378.82,62,,303.056,percent of total Billed Charges,62% of total Billed Charges,384.93,63,,307.944,percent of total Billed Charges,63% of total Billed Charges,378.82,62,,303.056,percent of total Billed Charges,62% of total Billed Charges,384.93,63,,307.944,percent of total billed charges,63% of total Billed Charges,378.82,62,,303.056,percent of total Billed Charges,62% of total Billed Charges,488.8,80,,391.04,percent of total Billed Charges,80% of Total Billed Charges,378.82,62,,303.056,percent of total Billed Charges,62% of total Billed Charges,378.82,62,,303.056,percent of total Billed Charges,62% of total Billed Charges,378.82,519.35,
96360 - Hydration first hour,220181,CDM,450,RC,96360,HCPCS,Outpatient,,,216,151.2,,172.8,80,,138.24,percent of total Billed Charges,80% of Total Billed Charges,136.08,63,,108.864,percent of total Billed charges,63% of Total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total BIlled charges,136.08,63,,108.864,percent of total Billed Charges,63% of total Billed Charges,183.6,85,,146.88,percent of total Billed Charges,85% of total Billed Charges,172.8,80,,138.24,percent of total Billed Charges,80% of total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total Billed Charges,136.08,63,,108.864,percent of total Billed Charges,63% of total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total Billed Charges,136.08,63,,108.864,percent of total billed charges,63% of total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total Billed Charges,172.8,80,,138.24,percent of total Billed Charges,80% of Total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total Billed Charges,133.92,183.6,
96361- Hydration each additional hour,220182,CDM,450,RC,96361,HCPCS,Outpatient,,,61,42.7,,48.8,80,,39.04,percent of total Billed Charges,80% of Total Billed Charges,38.43,63,,30.744,percent of total Billed charges,63% of Total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total BIlled charges,38.43,63,,30.744,percent of total Billed Charges,63% of total Billed Charges,51.85,85,,41.48,percent of total Billed Charges,85% of total Billed Charges,48.8,80,,39.04,percent of total Billed Charges,80% of total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total Billed Charges,38.43,63,,30.744,percent of total Billed Charges,63% of total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total Billed Charges,38.43,63,,30.744,percent of total billed charges,63% of total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total Billed Charges,48.8,80,,39.04,percent of total Billed Charges,80% of Total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total Billed Charges,37.82,51.85,
96365- IV tx first hour,220194,CDM,450,RC,96365,HCPCS,Outpatient,,,168,117.6,,134.4,80,,107.52,percent of total Billed Charges,80% of Total Billed Charges,105.84,63,,84.672,percent of total Billed charges,63% of Total Billed Charges,104.16,62,,83.328,percent of total Billed Charges,62% of total BIlled charges,105.84,63,,84.672,percent of total Billed Charges,63% of total Billed Charges,142.8,85,,114.24,percent of total Billed Charges,85% of total Billed Charges,134.4,80,,107.52,percent of total Billed Charges,80% of total Billed Charges,104.16,62,,83.328,percent of total Billed Charges,62% of total Billed Charges,105.84,63,,84.672,percent of total Billed Charges,63% of total Billed Charges,104.16,62,,83.328,percent of total Billed Charges,62% of total Billed Charges,105.84,63,,84.672,percent of total billed charges,63% of total Billed Charges,104.16,62,,83.328,percent of total Billed Charges,62% of total Billed Charges,134.4,80,,107.52,percent of total Billed Charges,80% of Total Billed Charges,104.16,62,,83.328,percent of total Billed Charges,62% of total Billed Charges,104.16,62,,83.328,percent of total Billed Charges,62% of total Billed Charges,104.16,142.8,
96366- IV tx each additional hour,220195,CDM,450,RC,96366,HCPCS,Outpatient,,,61,42.7,,48.8,80,,39.04,percent of total Billed Charges,80% of Total Billed Charges,38.43,63,,30.744,percent of total Billed charges,63% of Total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total BIlled charges,38.43,63,,30.744,percent of total Billed Charges,63% of total Billed Charges,51.85,85,,41.48,percent of total Billed Charges,85% of total Billed Charges,48.8,80,,39.04,percent of total Billed Charges,80% of total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total Billed Charges,38.43,63,,30.744,percent of total Billed Charges,63% of total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total Billed Charges,38.43,63,,30.744,percent of total billed charges,63% of total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total Billed Charges,48.8,80,,39.04,percent of total Billed Charges,80% of Total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total Billed Charges,37.82,62,,30.256,percent of total Billed Charges,62% of total Billed Charges,37.82,51.85,
"96367- IV tx, sequential infusion",220190,CDM,450,RC,96367,HCPCS,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,56.7,63,,45.36,percent of total Billed charges,63% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total BIlled charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total billed charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,76.5,
"96368- IV tx, concurrent infusion",220210,CDM,450,RC,96368,HCPCS,Outpatient,,,81,56.7,,64.8,80,,51.84,percent of total Billed Charges,80% of Total Billed Charges,51.03,63,,40.824,percent of total Billed charges,63% of Total Billed Charges,50.22,62,,40.176,percent of total Billed Charges,62% of total BIlled charges,51.03,63,,40.824,percent of total Billed Charges,63% of total Billed Charges,68.85,85,,55.08,percent of total Billed Charges,85% of total Billed Charges,64.8,80,,51.84,percent of total Billed Charges,80% of total Billed Charges,50.22,62,,40.176,percent of total Billed Charges,62% of total Billed Charges,51.03,63,,40.824,percent of total Billed Charges,63% of total Billed Charges,50.22,62,,40.176,percent of total Billed Charges,62% of total Billed Charges,51.03,63,,40.824,percent of total billed charges,63% of total Billed Charges,50.22,62,,40.176,percent of total Billed Charges,62% of total Billed Charges,64.8,80,,51.84,percent of total Billed Charges,80% of Total Billed Charges,50.22,62,,40.176,percent of total Billed Charges,62% of total Billed Charges,50.22,62,,40.176,percent of total Billed Charges,62% of total Billed Charges,50.22,68.85,
96372- Subq/IM Injection,220034,CDM,450,RC,96372,HCPCS,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,56.7,63,,45.36,percent of total Billed charges,63% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total BIlled charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total billed charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,76.5,
96373- Intra-Arterial Injection,220225,CDM,450,RC,96373,HCPCS,Outpatient,,,221,154.7,,176.8,80,,141.44,percent of total Billed Charges,80% of Total Billed Charges,139.23,63,,111.384,percent of total Billed charges,63% of Total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total BIlled charges,139.23,63,,111.384,percent of total Billed Charges,63% of total Billed Charges,187.85,85,,150.28,percent of total Billed Charges,85% of total Billed Charges,176.8,80,,141.44,percent of total Billed Charges,80% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,139.23,63,,111.384,percent of total Billed Charges,63% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,139.23,63,,111.384,percent of total billed charges,63% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,176.8,80,,141.44,percent of total Billed Charges,80% of Total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,137.02,187.85,
"96375- IV Injection, add new drug",220226,CDM,450,RC,96375,HCPCS,Outpatient,,,67,46.9,,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,42.21,63,,33.768,percent of total Billed charges,63% of Total Billed Charges,41.54,62,,33.232,percent of total Billed Charges,62% of total BIlled charges,42.21,63,,33.768,percent of total Billed Charges,63% of total Billed Charges,56.95,85,,45.56,percent of total Billed Charges,85% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of total Billed Charges,41.54,62,,33.232,percent of total Billed Charges,62% of total Billed Charges,42.21,63,,33.768,percent of total Billed Charges,63% of total Billed Charges,41.54,62,,33.232,percent of total Billed Charges,62% of total Billed Charges,42.21,63,,33.768,percent of total billed charges,63% of total Billed Charges,41.54,62,,33.232,percent of total Billed Charges,62% of total Billed Charges,53.6,80,,42.88,percent of total Billed Charges,80% of Total Billed Charges,41.54,62,,33.232,percent of total Billed Charges,62% of total Billed Charges,41.54,62,,33.232,percent of total Billed Charges,62% of total Billed Charges,41.54,56.95,
"96376- IV Injection, add same drug",220227,CDM,450,RC,96376,HCPCS,Outpatient,,,51,35.7,,40.8,80,,32.64,percent of total Billed Charges,80% of Total Billed Charges,32.13,63,,25.704,percent of total Billed charges,63% of Total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total BIlled charges,32.13,63,,25.704,percent of total Billed Charges,63% of total Billed Charges,43.35,85,,34.68,percent of total Billed Charges,85% of total Billed Charges,40.8,80,,32.64,percent of total Billed Charges,80% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,32.13,63,,25.704,percent of total Billed Charges,63% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,32.13,63,,25.704,percent of total billed charges,63% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,40.8,80,,32.64,percent of total Billed Charges,80% of Total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,31.62,62,,25.296,percent of total Billed Charges,62% of total Billed Charges,31.62,43.35,
99281 - Level 1,220008,CDM,450,RC,99281,HCPCS,Outpatient,,,114,79.8,,91.2,80,,72.96,percent of total Billed Charges,80% of Total Billed Charges,71.82,63,,57.456,percent of total Billed charges,63% of Total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total BIlled charges,71.82,63,,57.456,percent of total Billed Charges,63% of total Billed Charges,96.9,85,,77.52,percent of total Billed Charges,85% of total Billed Charges,91.2,80,,72.96,percent of total Billed Charges,80% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,71.82,63,,57.456,percent of total Billed Charges,63% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,71.82,63,,57.456,percent of total billed charges,63% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,91.2,80,,72.96,percent of total Billed Charges,80% of Total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,70.68,96.9,
99282 - Level 2,220009,CDM,450,RC,99282,HCPCS,Outpatient,,,206,144.2,,164.8,80,,131.84,percent of total Billed Charges,80% of Total Billed Charges,129.78,63,,103.824,percent of total Billed charges,63% of Total Billed Charges,127.72,62,,102.176,percent of total Billed Charges,62% of total BIlled charges,129.78,63,,103.824,percent of total Billed Charges,63% of total Billed Charges,175.1,85,,140.08,percent of total Billed Charges,85% of total Billed Charges,164.8,80,,131.84,percent of total Billed Charges,80% of total Billed Charges,127.72,62,,102.176,percent of total Billed Charges,62% of total Billed Charges,129.78,63,,103.824,percent of total Billed Charges,63% of total Billed Charges,127.72,62,,102.176,percent of total Billed Charges,62% of total Billed Charges,129.78,63,,103.824,percent of total billed charges,63% of total Billed Charges,127.72,62,,102.176,percent of total Billed Charges,62% of total Billed Charges,164.8,80,,131.84,percent of total Billed Charges,80% of Total Billed Charges,127.72,62,,102.176,percent of total Billed Charges,62% of total Billed Charges,127.72,62,,102.176,percent of total Billed Charges,62% of total Billed Charges,127.72,175.1,
99283 - Level 3,220010,CDM,450,RC,99283,HCPCS,Outpatient,,,340,238,,272,80,,217.6,percent of total Billed Charges,80% of Total Billed Charges,214.2,63,,171.36,percent of total Billed charges,63% of Total Billed Charges,210.8,62,,168.64,percent of total Billed Charges,62% of total BIlled charges,214.2,63,,171.36,percent of total Billed Charges,63% of total Billed Charges,289,85,,231.2,percent of total Billed Charges,85% of total Billed Charges,272,80,,217.6,percent of total Billed Charges,80% of total Billed Charges,210.8,62,,168.64,percent of total Billed Charges,62% of total Billed Charges,214.2,63,,171.36,percent of total Billed Charges,63% of total Billed Charges,210.8,62,,168.64,percent of total Billed Charges,62% of total Billed Charges,214.2,63,,171.36,percent of total billed charges,63% of total Billed Charges,210.8,62,,168.64,percent of total Billed Charges,62% of total Billed Charges,272,80,,217.6,percent of total Billed Charges,80% of Total Billed Charges,210.8,62,,168.64,percent of total Billed Charges,62% of total Billed Charges,210.8,62,,168.64,percent of total Billed Charges,62% of total Billed Charges,210.8,289,
99284 - Level 4,220011,CDM,450,RC,99284,HCPCS,Outpatient,,,600,420,,480,80,,384,percent of total Billed Charges,80% of Total Billed Charges,378,63,,302.4,percent of total Billed charges,63% of Total Billed Charges,372,62,,297.6,percent of total Billed Charges,62% of total BIlled charges,378,63,,302.4,percent of total Billed Charges,63% of total Billed Charges,510,85,,408,percent of total Billed Charges,85% of total Billed Charges,480,80,,384,percent of total Billed Charges,80% of total Billed Charges,372,62,,297.6,percent of total Billed Charges,62% of total Billed Charges,378,63,,302.4,percent of total Billed Charges,63% of total Billed Charges,372,62,,297.6,percent of total Billed Charges,62% of total Billed Charges,378,63,,302.4,percent of total billed charges,63% of total Billed Charges,372,62,,297.6,percent of total Billed Charges,62% of total Billed Charges,480,80,,384,percent of total Billed Charges,80% of Total Billed Charges,372,62,,297.6,percent of total Billed Charges,62% of total Billed Charges,372,62,,297.6,percent of total Billed Charges,62% of total Billed Charges,372,510,
99285 - Level 5,220012,CDM,450,RC,99285,HCPCS,Outpatient,,,930,651,,744,80,,595.2,percent of total Billed Charges,80% of Total Billed Charges,585.9,63,,468.72,percent of total Billed charges,63% of Total Billed Charges,576.6,62,,461.28,percent of total Billed Charges,62% of total BIlled charges,585.9,63,,468.72,percent of total Billed Charges,63% of total Billed Charges,790.5,85,,632.4,percent of total Billed Charges,85% of total Billed Charges,744,80,,595.2,percent of total Billed Charges,80% of total Billed Charges,576.6,62,,461.28,percent of total Billed Charges,62% of total Billed Charges,585.9,63,,468.72,percent of total Billed Charges,63% of total Billed Charges,576.6,62,,461.28,percent of total Billed Charges,62% of total Billed Charges,585.9,63,,468.72,percent of total billed charges,63% of total Billed Charges,576.6,62,,461.28,percent of total Billed Charges,62% of total Billed Charges,744,80,,595.2,percent of total Billed Charges,80% of Total Billed Charges,576.6,62,,461.28,percent of total Billed Charges,62% of total Billed Charges,576.6,62,,461.28,percent of total Billed Charges,62% of total Billed Charges,576.6,790.5,
"99291 - Critical Care, First Hour",220032,CDM,450,RC,99291,HCPCS,Outpatient,,,1386,970.2,,1108.8,80,,887.04,percent of total Billed Charges,80% of Total Billed Charges,873.18,63,,698.544,percent of total Billed charges,63% of Total Billed Charges,859.32,62,,687.456,percent of total Billed Charges,62% of total BIlled charges,873.18,63,,698.544,percent of total Billed Charges,63% of total Billed Charges,1178.1,85,,942.48,percent of total Billed Charges,85% of total Billed Charges,1108.8,80,,887.04,percent of total Billed Charges,80% of total Billed Charges,859.32,62,,687.456,percent of total Billed Charges,62% of total Billed Charges,873.18,63,,698.544,percent of total Billed Charges,63% of total Billed Charges,859.32,62,,687.456,percent of total Billed Charges,62% of total Billed Charges,873.18,63,,698.544,percent of total billed charges,63% of total Billed Charges,859.32,62,,687.456,percent of total Billed Charges,62% of total Billed Charges,1108.8,80,,887.04,percent of total Billed Charges,80% of Total Billed Charges,859.32,62,,687.456,percent of total Billed Charges,62% of total Billed Charges,859.32,62,,687.456,percent of total Billed Charges,62% of total Billed Charges,859.32,1178.1,
"99292 - Critical Care, Addl 30 Min",220033,CDM,450,RC,99292,HCPCS,Outpatient,,,601,420.7,,480.8,80,,384.64,percent of total Billed Charges,80% of Total Billed Charges,378.63,63,,302.904,percent of total Billed charges,63% of Total Billed Charges,372.62,62,,298.096,percent of total Billed Charges,62% of total BIlled charges,378.63,63,,302.904,percent of total Billed Charges,63% of total Billed Charges,510.85,85,,408.68,percent of total Billed Charges,85% of total Billed Charges,480.8,80,,384.64,percent of total Billed Charges,80% of total Billed Charges,372.62,62,,298.096,percent of total Billed Charges,62% of total Billed Charges,378.63,63,,302.904,percent of total Billed Charges,63% of total Billed Charges,372.62,62,,298.096,percent of total Billed Charges,62% of total Billed Charges,378.63,63,,302.904,percent of total billed charges,63% of total Billed Charges,372.62,62,,298.096,percent of total Billed Charges,62% of total Billed Charges,480.8,80,,384.64,percent of total Billed Charges,80% of Total Billed Charges,372.62,62,,298.096,percent of total Billed Charges,62% of total Billed Charges,372.62,62,,298.096,percent of total Billed Charges,62% of total Billed Charges,372.62,510.85,
36680 - Insert new site,220080,CDM,450,RC,36680,HCPCS,Outpatient,,,109,76.3,,87.2,80,,69.76,percent of total Billed Charges,80% of Total Billed Charges,68.67,63,,54.936,percent of total Billed charges,63% of Total Billed Charges,67.58,62,,54.064,percent of total Billed Charges,62% of total BIlled charges,68.67,63,,54.936,percent of total Billed Charges,63% of total Billed Charges,92.65,85,,74.12,percent of total Billed Charges,85% of total Billed Charges,87.2,80,,69.76,percent of total Billed Charges,80% of total Billed Charges,67.58,62,,54.064,percent of total Billed Charges,62% of total Billed Charges,68.67,63,,54.936,percent of total Billed Charges,63% of total Billed Charges,67.58,62,,54.064,percent of total Billed Charges,62% of total Billed Charges,68.67,63,,54.936,percent of total billed charges,63% of total Billed Charges,67.58,62,,54.064,percent of total Billed Charges,62% of total Billed Charges,87.2,80,,69.76,percent of total Billed Charges,80% of Total Billed Charges,67.58,62,,54.064,percent of total Billed Charges,62% of total Billed Charges,67.58,62,,54.064,percent of total Billed Charges,62% of total Billed Charges,67.58,92.65,
10060 - INCISION  and DRAINAGE ABSCESS SIMPLE/SINGLE TechFee,220087,CDM,450,RC,10060,HCPCS,Outpatient,,,326,228.2,,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,205.38,63,,164.304,percent of total Billed charges,63% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total BIlled charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,277.1,85,,221.68,percent of total Billed Charges,85% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total billed charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,277.1,
10061 - INCISION  DRAINAGE ABSCESS COMPLICATED/MULTIPLE TechFee,220305,CDM,450,RC,10061,HCPCS,Outpatient,,,629,440.3,,503.2,80,,402.56,percent of total Billed Charges,80% of Total Billed Charges,396.27,63,,317.016,percent of total Billed charges,63% of Total Billed Charges,389.98,62,,311.984,percent of total Billed Charges,62% of total BIlled charges,396.27,63,,317.016,percent of total Billed Charges,63% of total Billed Charges,534.65,85,,427.72,percent of total Billed Charges,85% of total Billed Charges,503.2,80,,402.56,percent of total Billed Charges,80% of total Billed Charges,389.98,62,,311.984,percent of total Billed Charges,62% of total Billed Charges,396.27,63,,317.016,percent of total Billed Charges,63% of total Billed Charges,389.98,62,,311.984,percent of total Billed Charges,62% of total Billed Charges,396.27,63,,317.016,percent of total billed charges,63% of total Billed Charges,389.98,62,,311.984,percent of total Billed Charges,62% of total Billed Charges,503.2,80,,402.56,percent of total Billed Charges,80% of Total Billed Charges,389.98,62,,311.984,percent of total Billed Charges,62% of total Billed Charges,389.98,62,,311.984,percent of total Billed Charges,62% of total Billed Charges,389.98,534.65,
10080 - INCISION  DRAINAGE PILONIDAL CYST SIMPLE TechFee,220088,CDM,450,RC,10080,HCPCS,Outpatient,,,326,228.2,,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,205.38,63,,164.304,percent of total Billed charges,63% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total BIlled charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,277.1,85,,221.68,percent of total Billed Charges,85% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total billed charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,277.1,
10120 - INCISION  REMOVAL FOREIGN BODY SUBQ TISS SIMPLE TechFee,220089,CDM,450,RC,10120,HCPCS,Outpatient,,,561,392.7,,448.8,80,,359.04,percent of total Billed Charges,80% of Total Billed Charges,353.43,63,,282.744,percent of total Billed charges,63% of Total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total BIlled charges,353.43,63,,282.744,percent of total Billed Charges,63% of total Billed Charges,476.85,85,,381.48,percent of total Billed Charges,85% of total Billed Charges,448.8,80,,359.04,percent of total Billed Charges,80% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,353.43,63,,282.744,percent of total Billed Charges,63% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,353.43,63,,282.744,percent of total billed charges,63% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,448.8,80,,359.04,percent of total Billed Charges,80% of Total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,347.82,476.85,
10121 - INCISION  REMOVAL FOREIGN BODY SUBQ TISS COMPL TechFee,220137,CDM,450,RC,10121,HCPCS,Outpatient,,,2339,1637.3,,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1473.57,63,,1178.856,percent of total Billed charges,63% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total BIlled charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1988.15,85,,1590.52,percent of total Billed Charges,85% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total billed charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,1988.15,
10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST TechFee,220144,CDM,450,RC,10160,HCPCS,Outpatient,,,326,228.2,,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,205.38,63,,164.304,percent of total Billed charges,63% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total BIlled charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,277.1,85,,221.68,percent of total Billed Charges,85% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total billed charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,277.1,
10180 - INCISION AND DRAINAGE COMPLEX POSTOPERATIVE WOUND INFECTION TechFee,220123,CDM,450,RC,10180,HCPCS,Outpatient,,,3202,2241.4,,2561.6,80,,2049.28,percent of total Billed Charges,80% of Total Billed Charges,2017.26,63,,1613.808,percent of total Billed charges,63% of Total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total BIlled charges,2017.26,63,,1613.808,percent of total Billed Charges,63% of total Billed Charges,2721.7,85,,2177.36,percent of total Billed Charges,85% of total Billed Charges,2561.6,80,,2049.28,percent of total Billed Charges,80% of total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,2017.26,63,,1613.808,percent of total Billed Charges,63% of total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,2017.26,63,,1613.808,percent of total billed charges,63% of total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,2561.6,80,,2049.28,percent of total Billed Charges,80% of Total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,1985.24,62,,1588.192,percent of total Billed Charges,62% of total Billed Charges,1985.24,2721.7,
11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF TechFee,220041,CDM,450,RC,11000,HCPCS,Outpatient,,,561,392.7,,448.8,80,,359.04,percent of total Billed Charges,80% of Total Billed Charges,353.43,63,,282.744,percent of total Billed charges,63% of Total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total BIlled charges,353.43,63,,282.744,percent of total Billed Charges,63% of total Billed Charges,476.85,85,,381.48,percent of total Billed Charges,85% of total Billed Charges,448.8,80,,359.04,percent of total Billed Charges,80% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,353.43,63,,282.744,percent of total Billed Charges,63% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,353.43,63,,282.744,percent of total billed charges,63% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,448.8,80,,359.04,percent of total Billed Charges,80% of Total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,347.82,476.85,
11720 - DEBRIDEMENT NAIL ANY METHOD 1-5 TechFee,220200,CDM,450,RC,11720,HCPCS,Outpatient,,,107,74.9,,85.6,80,,68.48,percent of total Billed Charges,80% of Total Billed Charges,67.41,63,,53.928,percent of total Billed charges,63% of Total Billed Charges,66.34,62,,53.072,percent of total Billed Charges,62% of total BIlled charges,67.41,63,,53.928,percent of total Billed Charges,63% of total Billed Charges,90.95,85,,72.76,percent of total Billed Charges,85% of total Billed Charges,85.6,80,,68.48,percent of total Billed Charges,80% of total Billed Charges,66.34,62,,53.072,percent of total Billed Charges,62% of total Billed Charges,67.41,63,,53.928,percent of total Billed Charges,63% of total Billed Charges,66.34,62,,53.072,percent of total Billed Charges,62% of total Billed Charges,67.41,63,,53.928,percent of total billed charges,63% of total Billed Charges,66.34,62,,53.072,percent of total Billed Charges,62% of total Billed Charges,85.6,80,,68.48,percent of total Billed Charges,80% of Total Billed Charges,66.34,62,,53.072,percent of total Billed Charges,62% of total Billed Charges,66.34,62,,53.072,percent of total Billed Charges,62% of total Billed Charges,66.34,90.95,
11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 TechFee,220108,CDM,450,RC,11730,HCPCS,Outpatient,,,301,210.7,,240.8,80,,192.64,percent of total Billed Charges,80% of Total Billed Charges,189.63,63,,151.704,percent of total Billed charges,63% of Total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total BIlled charges,189.63,63,,151.704,percent of total Billed Charges,63% of total Billed Charges,255.85,85,,204.68,percent of total Billed Charges,85% of total Billed Charges,240.8,80,,192.64,percent of total Billed Charges,80% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,189.63,63,,151.704,percent of total Billed Charges,63% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,189.63,63,,151.704,percent of total billed charges,63% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,240.8,80,,192.64,percent of total Billed Charges,80% of Total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,186.62,62,,149.296,percent of total Billed Charges,62% of total Billed Charges,186.62,255.85,
11732 - AVULSION OF NAIL PLATE PARTIAL OR COMPLETE SIMPLE; EACH AD TechFee,220199,CDM,450,RC,11732,HCPCS,Outpatient,,,66,46.2,,52.8,80,,42.24,percent of total Billed Charges,80% of Total Billed Charges,41.58,63,,33.264,percent of total Billed charges,63% of Total Billed Charges,40.92,62,,32.736,percent of total Billed Charges,62% of total BIlled charges,41.58,63,,33.264,percent of total Billed Charges,63% of total Billed Charges,56.1,85,,44.88,percent of total Billed Charges,85% of total Billed Charges,52.8,80,,42.24,percent of total Billed Charges,80% of total Billed Charges,40.92,62,,32.736,percent of total Billed Charges,62% of total Billed Charges,41.58,63,,33.264,percent of total Billed Charges,63% of total Billed Charges,40.92,62,,32.736,percent of total Billed Charges,62% of total Billed Charges,41.58,63,,33.264,percent of total billed charges,63% of total Billed Charges,40.92,62,,32.736,percent of total Billed Charges,62% of total Billed Charges,52.8,80,,42.24,percent of total Billed Charges,80% of Total Billed Charges,40.92,62,,32.736,percent of total Billed Charges,62% of total Billed Charges,40.92,62,,32.736,percent of total Billed Charges,62% of total Billed Charges,40.92,56.1,
11740 - EVACUATION SUBUNGUAL HEMATOMA TechFee,220145,CDM,450,RC,11740,HCPCS,Outpatient,,,124,86.8,,99.2,80,,79.36,percent of total Billed Charges,80% of Total Billed Charges,78.12,63,,62.496,percent of total Billed charges,63% of Total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total BIlled charges,78.12,63,,62.496,percent of total Billed Charges,63% of total Billed Charges,105.4,85,,84.32,percent of total Billed Charges,85% of total Billed Charges,99.2,80,,79.36,percent of total Billed Charges,80% of total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total Billed Charges,78.12,63,,62.496,percent of total Billed Charges,63% of total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total Billed Charges,78.12,63,,62.496,percent of total billed charges,63% of total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total Billed Charges,99.2,80,,79.36,percent of total Billed Charges,80% of Total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total Billed Charges,76.88,105.4,
11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL TechFee,220047,CDM,450,RC,11750,HCPCS,Outpatient,,,651,455.7,,520.8,80,,416.64,percent of total Billed Charges,80% of Total Billed Charges,410.13,63,,328.104,percent of total Billed charges,63% of Total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total BIlled charges,410.13,63,,328.104,percent of total Billed Charges,63% of total Billed Charges,553.35,85,,442.68,percent of total Billed Charges,85% of total Billed Charges,520.8,80,,416.64,percent of total Billed Charges,80% of total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total Billed Charges,410.13,63,,328.104,percent of total Billed Charges,63% of total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total Billed Charges,410.13,63,,328.104,percent of total billed charges,63% of total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total Billed Charges,520.8,80,,416.64,percent of total Billed Charges,80% of Total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total Billed Charges,403.62,62,,322.896,percent of total Billed Charges,62% of total Billed Charges,403.62,553.35,
11760 - REPAIR NAIL BED TechFee,220048,CDM,450,RC,11760,HCPCS,Outpatient,,,407,284.9,,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,256.41,63,,205.128,percent of total Billed charges,63% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total BIlled charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,345.95,85,,276.76,percent of total Billed Charges,85% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total billed charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,345.95,
11765 - WEDGE EXCISION SKIN NAIL FOLD TechFee,220201,CDM,450,RC,11765,HCPCS,Outpatient,,,299,209.3,,239.2,80,,191.36,percent of total Billed Charges,80% of Total Billed Charges,188.37,63,,150.696,percent of total Billed charges,63% of Total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total BIlled charges,188.37,63,,150.696,percent of total Billed Charges,63% of total Billed Charges,254.15,85,,203.32,percent of total Billed Charges,85% of total Billed Charges,239.2,80,,191.36,percent of total Billed Charges,80% of total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total Billed Charges,188.37,63,,150.696,percent of total Billed Charges,63% of total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total Billed Charges,188.37,63,,150.696,percent of total billed charges,63% of total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total Billed Charges,239.2,80,,191.36,percent of total Billed Charges,80% of Total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total Billed Charges,185.38,254.15,
12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< TechFee,512001,CDM,450,RC,12001,HCPCS,Outpatient,,,171,119.7,,136.8,80,,109.44,percent of total Billed Charges,80% of Total Billed Charges,107.73,63,,86.184,percent of total Billed charges,63% of Total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total BIlled charges,107.73,63,,86.184,percent of total Billed Charges,63% of total Billed Charges,145.35,85,,116.28,percent of total Billed Charges,85% of total Billed Charges,136.8,80,,109.44,percent of total Billed Charges,80% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,107.73,63,,86.184,percent of total Billed Charges,63% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,107.73,63,,86.184,percent of total billed charges,63% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,136.8,80,,109.44,percent of total Billed Charges,80% of Total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,106.02,145.35,
12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM TechFee,512002,CDM,450,RC,12002,HCPCS,Outpatient,,,171,119.7,,136.8,80,,109.44,percent of total Billed Charges,80% of Total Billed Charges,107.73,63,,86.184,percent of total Billed charges,63% of Total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total BIlled charges,107.73,63,,86.184,percent of total Billed Charges,63% of total Billed Charges,145.35,85,,116.28,percent of total Billed Charges,85% of total Billed Charges,136.8,80,,109.44,percent of total Billed Charges,80% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,107.73,63,,86.184,percent of total Billed Charges,63% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,107.73,63,,86.184,percent of total billed charges,63% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,136.8,80,,109.44,percent of total Billed Charges,80% of Total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,106.02,145.35,
12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM TechFee,512004,CDM,450,RC,12004,HCPCS,Outpatient,,,171,119.7,,136.8,80,,109.44,percent of total Billed Charges,80% of Total Billed Charges,107.73,63,,86.184,percent of total Billed charges,63% of Total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total BIlled charges,107.73,63,,86.184,percent of total Billed Charges,63% of total Billed Charges,145.35,85,,116.28,percent of total Billed Charges,85% of total Billed Charges,136.8,80,,109.44,percent of total Billed Charges,80% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,107.73,63,,86.184,percent of total Billed Charges,63% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,107.73,63,,86.184,percent of total billed charges,63% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,136.8,80,,109.44,percent of total Billed Charges,80% of Total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,106.02,145.35,
12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM TechFee,512005,CDM,450,RC,12005,HCPCS,Outpatient,,,171,119.7,,136.8,80,,109.44,percent of total Billed Charges,80% of Total Billed Charges,107.73,63,,86.184,percent of total Billed charges,63% of Total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total BIlled charges,107.73,63,,86.184,percent of total Billed Charges,63% of total Billed Charges,145.35,85,,116.28,percent of total Billed Charges,85% of total Billed Charges,136.8,80,,109.44,percent of total Billed Charges,80% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,107.73,63,,86.184,percent of total Billed Charges,63% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,107.73,63,,86.184,percent of total billed charges,63% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,136.8,80,,109.44,percent of total Billed Charges,80% of Total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,106.02,145.35,
12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM TechFee,512006,CDM,450,RC,12006,HCPCS,Outpatient,,,449,314.3,,359.2,80,,287.36,percent of total Billed Charges,80% of Total Billed Charges,282.87,63,,226.296,percent of total Billed charges,63% of Total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total BIlled charges,282.87,63,,226.296,percent of total Billed Charges,63% of total Billed Charges,381.65,85,,305.32,percent of total Billed Charges,85% of total Billed Charges,359.2,80,,287.36,percent of total Billed Charges,80% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,282.87,63,,226.296,percent of total Billed Charges,63% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,282.87,63,,226.296,percent of total billed charges,63% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,359.2,80,,287.36,percent of total Billed Charges,80% of Total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,278.38,381.65,
12011 - SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< TechFee,512011,CDM,450,RC,12011,HCPCS,Outpatient,,,171,119.7,,136.8,80,,109.44,percent of total Billed Charges,80% of Total Billed Charges,107.73,63,,86.184,percent of total Billed charges,63% of Total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total BIlled charges,107.73,63,,86.184,percent of total Billed Charges,63% of total Billed Charges,145.35,85,,116.28,percent of total Billed Charges,85% of total Billed Charges,136.8,80,,109.44,percent of total Billed Charges,80% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,107.73,63,,86.184,percent of total Billed Charges,63% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,107.73,63,,86.184,percent of total billed charges,63% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,136.8,80,,109.44,percent of total Billed Charges,80% of Total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,106.02,145.35,
12013 - SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM TechFee,512013,CDM,450,RC,12013,HCPCS,Outpatient,,,171,119.7,,136.8,80,,109.44,percent of total Billed Charges,80% of Total Billed Charges,107.73,63,,86.184,percent of total Billed charges,63% of Total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total BIlled charges,107.73,63,,86.184,percent of total Billed Charges,63% of total Billed Charges,145.35,85,,116.28,percent of total Billed Charges,85% of total Billed Charges,136.8,80,,109.44,percent of total Billed Charges,80% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,107.73,63,,86.184,percent of total Billed Charges,63% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,107.73,63,,86.184,percent of total billed charges,63% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,136.8,80,,109.44,percent of total Billed Charges,80% of Total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,106.02,145.35,
12014 - SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM TechFee,512014,CDM,450,RC,12014,HCPCS,Outpatient,,,171,119.7,,136.8,80,,109.44,percent of total Billed Charges,80% of Total Billed Charges,107.73,63,,86.184,percent of total Billed charges,63% of Total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total BIlled charges,107.73,63,,86.184,percent of total Billed Charges,63% of total Billed Charges,145.35,85,,116.28,percent of total Billed Charges,85% of total Billed Charges,136.8,80,,109.44,percent of total Billed Charges,80% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,107.73,63,,86.184,percent of total Billed Charges,63% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,107.73,63,,86.184,percent of total billed charges,63% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,136.8,80,,109.44,percent of total Billed Charges,80% of Total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,106.02,145.35,
12015 - SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM TechFee,512015,CDM,450,RC,12015,HCPCS,Outpatient,,,171,119.7,,136.8,80,,109.44,percent of total Billed Charges,80% of Total Billed Charges,107.73,63,,86.184,percent of total Billed charges,63% of Total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total BIlled charges,107.73,63,,86.184,percent of total Billed Charges,63% of total Billed Charges,145.35,85,,116.28,percent of total Billed Charges,85% of total Billed Charges,136.8,80,,109.44,percent of total Billed Charges,80% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,107.73,63,,86.184,percent of total Billed Charges,63% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,107.73,63,,86.184,percent of total billed charges,63% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,136.8,80,,109.44,percent of total Billed Charges,80% of Total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,106.02,145.35,
12016 - SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM TechFee,512016,CDM,450,RC,12016,HCPCS,Outpatient,,,299,209.3,,239.2,80,,191.36,percent of total Billed Charges,80% of Total Billed Charges,188.37,63,,150.696,percent of total Billed charges,63% of Total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total BIlled charges,188.37,63,,150.696,percent of total Billed Charges,63% of total Billed Charges,254.15,85,,203.32,percent of total Billed Charges,85% of total Billed Charges,239.2,80,,191.36,percent of total Billed Charges,80% of total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total Billed Charges,188.37,63,,150.696,percent of total Billed Charges,63% of total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total Billed Charges,188.37,63,,150.696,percent of total billed charges,63% of total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total Billed Charges,239.2,80,,191.36,percent of total Billed Charges,80% of Total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total Billed Charges,185.38,254.15,
12017 - SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM TechFee,512017,CDM,450,RC,12017,HCPCS,Outpatient,,,299,209.3,,239.2,80,,191.36,percent of total Billed Charges,80% of Total Billed Charges,188.37,63,,150.696,percent of total Billed charges,63% of Total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total BIlled charges,188.37,63,,150.696,percent of total Billed Charges,63% of total Billed Charges,254.15,85,,203.32,percent of total Billed Charges,85% of total Billed Charges,239.2,80,,191.36,percent of total Billed Charges,80% of total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total Billed Charges,188.37,63,,150.696,percent of total Billed Charges,63% of total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total Billed Charges,188.37,63,,150.696,percent of total billed charges,63% of total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total Billed Charges,239.2,80,,191.36,percent of total Billed Charges,80% of Total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total Billed Charges,185.38,254.15,
12018 - SIMPLE REPAIR F/E/E/N/L/M >30.0 CM TechFee,512018,CDM,450,RC,12018,HCPCS,Outpatient,,,299,209.3,,239.2,80,,191.36,percent of total Billed Charges,80% of Total Billed Charges,188.37,63,,150.696,percent of total Billed charges,63% of Total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total BIlled charges,188.37,63,,150.696,percent of total Billed Charges,63% of total Billed Charges,254.15,85,,203.32,percent of total Billed Charges,85% of total Billed Charges,239.2,80,,191.36,percent of total Billed Charges,80% of total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total Billed Charges,188.37,63,,150.696,percent of total Billed Charges,63% of total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total Billed Charges,188.37,63,,150.696,percent of total billed charges,63% of total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total Billed Charges,239.2,80,,191.36,percent of total Billed Charges,80% of Total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total Billed Charges,185.38,62,,148.304,percent of total Billed Charges,62% of total Billed Charges,185.38,254.15,
12031 - REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< TechFee,512031,CDM,450,RC,12031,HCPCS,Outpatient,,,407,284.9,,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,256.41,63,,205.128,percent of total Billed charges,63% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total BIlled charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,345.95,85,,276.76,percent of total Billed Charges,85% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total billed charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,345.95,
12032 - REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM TechFee,512032,CDM,450,RC,12032,HCPCS,Outpatient,,,407,284.9,,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,256.41,63,,205.128,percent of total Billed charges,63% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total BIlled charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,345.95,85,,276.76,percent of total Billed Charges,85% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total billed charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,345.95,
12034 - REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM TechFee,512034,CDM,450,RC,12034,HCPCS,Outpatient,,,407,284.9,,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,256.41,63,,205.128,percent of total Billed charges,63% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total BIlled charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,345.95,85,,276.76,percent of total Billed Charges,85% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total billed charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,345.95,
12035 - REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM TechFee,220191,CDM,450,RC,12035,HCPCS,Outpatient,,,835,584.5,,668,80,,534.4,percent of total Billed Charges,80% of Total Billed Charges,526.05,63,,420.84,percent of total Billed charges,63% of Total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total BIlled charges,526.05,63,,420.84,percent of total Billed Charges,63% of total Billed Charges,709.75,85,,567.8,percent of total Billed Charges,85% of total Billed Charges,668,80,,534.4,percent of total Billed Charges,80% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,526.05,63,,420.84,percent of total Billed Charges,63% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,526.05,63,,420.84,percent of total billed charges,63% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,668,80,,534.4,percent of total Billed Charges,80% of Total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,517.7,709.75,
12036 - REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM TechFee,512036,CDM,450,RC,12036,HCPCS,Outpatient,,,878,614.6,,702.4,80,,561.92,percent of total Billed Charges,80% of Total Billed Charges,553.14,63,,442.512,percent of total Billed charges,63% of Total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total BIlled charges,553.14,63,,442.512,percent of total Billed Charges,63% of total Billed Charges,746.3,85,,597.04,percent of total Billed Charges,85% of total Billed Charges,702.4,80,,561.92,percent of total Billed Charges,80% of total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total Billed Charges,553.14,63,,442.512,percent of total Billed Charges,63% of total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total Billed Charges,553.14,63,,442.512,percent of total billed charges,63% of total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total Billed Charges,702.4,80,,561.92,percent of total Billed Charges,80% of Total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total Billed Charges,544.36,746.3,
12037 - REPAIR INTERMEDIATE S/A/T/E >30.0 CM TechFee,512037,CDM,450,RC,12037,HCPCS,Outpatient,,,878,614.6,,702.4,80,,561.92,percent of total Billed Charges,80% of Total Billed Charges,553.14,63,,442.512,percent of total Billed charges,63% of Total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total BIlled charges,553.14,63,,442.512,percent of total Billed Charges,63% of total Billed Charges,746.3,85,,597.04,percent of total Billed Charges,85% of total Billed Charges,702.4,80,,561.92,percent of total Billed Charges,80% of total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total Billed Charges,553.14,63,,442.512,percent of total Billed Charges,63% of total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total Billed Charges,553.14,63,,442.512,percent of total billed charges,63% of total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total Billed Charges,702.4,80,,561.92,percent of total Billed Charges,80% of Total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total Billed Charges,544.36,746.3,
12041 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< TechFee,512041,CDM,450,RC,12041,HCPCS,Outpatient,,,407,284.9,,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,256.41,63,,205.128,percent of total Billed charges,63% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total BIlled charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,345.95,85,,276.76,percent of total Billed Charges,85% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total billed charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,345.95,
12042 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM TechFee,512042,CDM,450,RC,12042,HCPCS,Outpatient,,,407,284.9,,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,256.41,63,,205.128,percent of total Billed charges,63% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total BIlled charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,345.95,85,,276.76,percent of total Billed Charges,85% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total billed charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,345.95,
12044 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM TechFee,512044,CDM,450,RC,12044,HCPCS,Outpatient,,,407,284.9,,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,256.41,63,,205.128,percent of total Billed charges,63% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total BIlled charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,345.95,85,,276.76,percent of total Billed Charges,85% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total billed charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,345.95,
12045 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM TechFee,512045,CDM,450,RC,12045,HCPCS,Outpatient,,,449,314.3,,359.2,80,,287.36,percent of total Billed Charges,80% of Total Billed Charges,282.87,63,,226.296,percent of total Billed charges,63% of Total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total BIlled charges,282.87,63,,226.296,percent of total Billed Charges,63% of total Billed Charges,381.65,85,,305.32,percent of total Billed Charges,85% of total Billed Charges,359.2,80,,287.36,percent of total Billed Charges,80% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,282.87,63,,226.296,percent of total Billed Charges,63% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,282.87,63,,226.296,percent of total billed charges,63% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,359.2,80,,287.36,percent of total Billed Charges,80% of Total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,278.38,381.65,
12046 - RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM TechFee,512046,CDM,450,RC,12046,HCPCS,Outpatient,,,449,314.3,,359.2,80,,287.36,percent of total Billed Charges,80% of Total Billed Charges,282.87,63,,226.296,percent of total Billed charges,63% of Total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total BIlled charges,282.87,63,,226.296,percent of total Billed Charges,63% of total Billed Charges,381.65,85,,305.32,percent of total Billed Charges,85% of total Billed Charges,359.2,80,,287.36,percent of total Billed Charges,80% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,282.87,63,,226.296,percent of total Billed Charges,63% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,282.87,63,,226.296,percent of total billed charges,63% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,359.2,80,,287.36,percent of total Billed Charges,80% of Total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,278.38,381.65,
12047 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM TechFee,512047,CDM,450,RC,12047,HCPCS,Outpatient,,,878,614.6,,702.4,80,,561.92,percent of total Billed Charges,80% of Total Billed Charges,553.14,63,,442.512,percent of total Billed charges,63% of Total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total BIlled charges,553.14,63,,442.512,percent of total Billed Charges,63% of total Billed Charges,746.3,85,,597.04,percent of total Billed Charges,85% of total Billed Charges,702.4,80,,561.92,percent of total Billed Charges,80% of total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total Billed Charges,553.14,63,,442.512,percent of total Billed Charges,63% of total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total Billed Charges,553.14,63,,442.512,percent of total billed charges,63% of total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total Billed Charges,702.4,80,,561.92,percent of total Billed Charges,80% of Total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total Billed Charges,544.36,746.3,
12051 - REPAIR INTERMEDIATE F/E/E/N/L/MUC 2.5 CM/< TechFee,512051,CDM,450,RC,12051,HCPCS,Outpatient,,,407,284.9,,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,256.41,63,,205.128,percent of total Billed charges,63% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total BIlled charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,345.95,85,,276.76,percent of total Billed Charges,85% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total billed charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,345.95,
12052 - REPAIR INTERMEDIATE F/E/E/N/L/MUC 2.6-5.0 CM TechFee,512052,CDM,450,RC,12052,HCPCS,Outpatient,,,407,284.9,,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,256.41,63,,205.128,percent of total Billed charges,63% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total BIlled charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,345.95,85,,276.76,percent of total Billed Charges,85% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total billed charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,345.95,
12053 - REPAIR INTERMEDIATE F/E/E/N/L/MUC 5.1-7.5 CM TechFee,512053,CDM,450,RC,12053,HCPCS,Outpatient,,,407,284.9,,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,256.41,63,,205.128,percent of total Billed charges,63% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total BIlled charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,345.95,85,,276.76,percent of total Billed Charges,85% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total billed charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,345.95,
12054 - REPAIR INTERMEDIATE F/E/E/N/L/MUC 7.6-12.5 CM TechFee,512054,CDM,450,RC,12054,HCPCS,Outpatient,,,449,314.3,,359.2,80,,287.36,percent of total Billed Charges,80% of Total Billed Charges,282.87,63,,226.296,percent of total Billed charges,63% of Total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total BIlled charges,282.87,63,,226.296,percent of total Billed Charges,63% of total Billed Charges,381.65,85,,305.32,percent of total Billed Charges,85% of total Billed Charges,359.2,80,,287.36,percent of total Billed Charges,80% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,282.87,63,,226.296,percent of total Billed Charges,63% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,282.87,63,,226.296,percent of total billed charges,63% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,359.2,80,,287.36,percent of total Billed Charges,80% of Total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,278.38,381.65,
12055 - REPAIR INTERMEDIATE F/E/E/N/L/MUC 12.6-20.0CM TechFee,512055,CDM,450,RC,12055,HCPCS,Outpatient,,,449,314.3,,359.2,80,,287.36,percent of total Billed Charges,80% of Total Billed Charges,282.87,63,,226.296,percent of total Billed charges,63% of Total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total BIlled charges,282.87,63,,226.296,percent of total Billed Charges,63% of total Billed Charges,381.65,85,,305.32,percent of total Billed Charges,85% of total Billed Charges,359.2,80,,287.36,percent of total Billed Charges,80% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,282.87,63,,226.296,percent of total Billed Charges,63% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,282.87,63,,226.296,percent of total billed charges,63% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,359.2,80,,287.36,percent of total Billed Charges,80% of Total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,278.38,381.65,
12056 - REPAIR INTERMEDIATE F/E/E/N/L/MUC 20.1-30.0CM TechFee,512056,CDM,450,RC,12056,HCPCS,Outpatient,,,449,314.3,,359.2,80,,287.36,percent of total Billed Charges,80% of Total Billed Charges,282.87,63,,226.296,percent of total Billed charges,63% of Total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total BIlled charges,282.87,63,,226.296,percent of total Billed Charges,63% of total Billed Charges,381.65,85,,305.32,percent of total Billed Charges,85% of total Billed Charges,359.2,80,,287.36,percent of total Billed Charges,80% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,282.87,63,,226.296,percent of total Billed Charges,63% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,282.87,63,,226.296,percent of total billed charges,63% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,359.2,80,,287.36,percent of total Billed Charges,80% of Total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,278.38,381.65,
12057 - REPAIR INTERMEDIATE F/E/E/N/L/MUC >30.0 CM TechFee,512057,CDM,450,RC,12057,HCPCS,Outpatient,,,449,314.3,,359.2,80,,287.36,percent of total Billed Charges,80% of Total Billed Charges,282.87,63,,226.296,percent of total Billed charges,63% of Total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total BIlled charges,282.87,63,,226.296,percent of total Billed Charges,63% of total Billed Charges,381.65,85,,305.32,percent of total Billed Charges,85% of total Billed Charges,359.2,80,,287.36,percent of total Billed Charges,80% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,282.87,63,,226.296,percent of total Billed Charges,63% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,282.87,63,,226.296,percent of total billed charges,63% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,359.2,80,,287.36,percent of total Billed Charges,80% of Total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,278.38,62,,222.704,percent of total Billed Charges,62% of total Billed Charges,278.38,381.65,
13100 - REPAIR COMPLEX TRUNK 1.1-2.5 CM TechFee,513100,CDM,450,RC,13100,HCPCS,Outpatient,,,835,584.5,,668,80,,534.4,percent of total Billed Charges,80% of Total Billed Charges,526.05,63,,420.84,percent of total Billed charges,63% of Total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total BIlled charges,526.05,63,,420.84,percent of total Billed Charges,63% of total Billed Charges,709.75,85,,567.8,percent of total Billed Charges,85% of total Billed Charges,668,80,,534.4,percent of total Billed Charges,80% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,526.05,63,,420.84,percent of total Billed Charges,63% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,526.05,63,,420.84,percent of total billed charges,63% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,668,80,,534.4,percent of total Billed Charges,80% of Total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,517.7,709.75,
13101 - REPAIR COMPLEX TRUNK 2.6-7.5 CM TechFee,513101,CDM,450,RC,13101,HCPCS,Outpatient,,,835,584.5,,668,80,,534.4,percent of total Billed Charges,80% of Total Billed Charges,526.05,63,,420.84,percent of total Billed charges,63% of Total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total BIlled charges,526.05,63,,420.84,percent of total Billed Charges,63% of total Billed Charges,709.75,85,,567.8,percent of total Billed Charges,85% of total Billed Charges,668,80,,534.4,percent of total Billed Charges,80% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,526.05,63,,420.84,percent of total Billed Charges,63% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,526.05,63,,420.84,percent of total billed charges,63% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,668,80,,534.4,percent of total Billed Charges,80% of Total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,517.7,709.75,
13102 - REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/< TechFee,513102,CDM,450,RC,13102,HCPCS,Outpatient,,,125,87.5,,100,80,,80,percent of total Billed Charges,80% of Total Billed Charges,78.75,63,,63,percent of total Billed charges,63% of Total Billed Charges,77.5,62,,62,percent of total Billed Charges,62% of total BIlled charges,78.75,63,,63,percent of total Billed Charges,63% of total Billed Charges,106.25,85,,85,percent of total Billed Charges,85% of total Billed Charges,100,80,,80,percent of total Billed Charges,80% of total Billed Charges,77.5,62,,62,percent of total Billed Charges,62% of total Billed Charges,78.75,63,,63,percent of total Billed Charges,63% of total Billed Charges,77.5,62,,62,percent of total Billed Charges,62% of total Billed Charges,78.75,63,,63,percent of total billed charges,63% of total Billed Charges,77.5,62,,62,percent of total Billed Charges,62% of total Billed Charges,100,80,,80,percent of total Billed Charges,80% of Total Billed Charges,77.5,62,,62,percent of total Billed Charges,62% of total Billed Charges,77.5,62,,62,percent of total Billed Charges,62% of total Billed Charges,77.5,106.25,
13120 - REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM TechFee,513120,CDM,450,RC,13120,HCPCS,Outpatient,,,407,284.9,,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,256.41,63,,205.128,percent of total Billed charges,63% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total BIlled charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,345.95,85,,276.76,percent of total Billed Charges,85% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total billed charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,345.95,
13121 - REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM TechFee,513121,CDM,450,RC,13121,HCPCS,Outpatient,,,835,584.5,,668,80,,534.4,percent of total Billed Charges,80% of Total Billed Charges,526.05,63,,420.84,percent of total Billed charges,63% of Total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total BIlled charges,526.05,63,,420.84,percent of total Billed Charges,63% of total Billed Charges,709.75,85,,567.8,percent of total Billed Charges,85% of total Billed Charges,668,80,,534.4,percent of total Billed Charges,80% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,526.05,63,,420.84,percent of total Billed Charges,63% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,526.05,63,,420.84,percent of total billed charges,63% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,668,80,,534.4,percent of total Billed Charges,80% of Total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,517.7,709.75,
13131 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM TechFee,513131,CDM,450,RC,13131,HCPCS,Outpatient,,,407,284.9,,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,256.41,63,,205.128,percent of total Billed charges,63% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total BIlled charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,345.95,85,,276.76,percent of total Billed Charges,85% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total Billed Charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,256.41,63,,205.128,percent of total billed charges,63% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,325.6,80,,260.48,percent of total Billed Charges,80% of Total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,62,,201.872,percent of total Billed Charges,62% of total Billed Charges,252.34,345.95,
13132 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM TechFee,513132,CDM,450,RC,13132,HCPCS,Outpatient,,,835,584.5,,668,80,,534.4,percent of total Billed Charges,80% of Total Billed Charges,526.05,63,,420.84,percent of total Billed charges,63% of Total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total BIlled charges,526.05,63,,420.84,percent of total Billed Charges,63% of total Billed Charges,709.75,85,,567.8,percent of total Billed Charges,85% of total Billed Charges,668,80,,534.4,percent of total Billed Charges,80% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,526.05,63,,420.84,percent of total Billed Charges,63% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,526.05,63,,420.84,percent of total billed charges,63% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,668,80,,534.4,percent of total Billed Charges,80% of Total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,517.7,709.75,
13151 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM TechFee,513151,CDM,450,RC,13151,HCPCS,Outpatient,,,835,584.5,,668,80,,534.4,percent of total Billed Charges,80% of Total Billed Charges,526.05,63,,420.84,percent of total Billed charges,63% of Total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total BIlled charges,526.05,63,,420.84,percent of total Billed Charges,63% of total Billed Charges,709.75,85,,567.8,percent of total Billed Charges,85% of total Billed Charges,668,80,,534.4,percent of total Billed Charges,80% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,526.05,63,,420.84,percent of total Billed Charges,63% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,526.05,63,,420.84,percent of total billed charges,63% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,668,80,,534.4,percent of total Billed Charges,80% of Total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,517.7,62,,414.16,percent of total Billed Charges,62% of total Billed Charges,517.7,709.75,
13152 - REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM TechFee,513152,CDM,450,RC,13152,HCPCS,Outpatient,,,878,614.6,,702.4,80,,561.92,percent of total Billed Charges,80% of Total Billed Charges,553.14,63,,442.512,percent of total Billed charges,63% of Total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total BIlled charges,553.14,63,,442.512,percent of total Billed Charges,63% of total Billed Charges,746.3,85,,597.04,percent of total Billed Charges,85% of total Billed Charges,702.4,80,,561.92,percent of total Billed Charges,80% of total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total Billed Charges,553.14,63,,442.512,percent of total Billed Charges,63% of total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total Billed Charges,553.14,63,,442.512,percent of total billed charges,63% of total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total Billed Charges,702.4,80,,561.92,percent of total Billed Charges,80% of Total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total Billed Charges,544.36,62,,435.488,percent of total Billed Charges,62% of total Billed Charges,544.36,746.3,
16000 - INITIAL TX 1ST DEGREE BURN LOCAL TX TechFee,220161,CDM,450,RC,16000,HCPCS,Outpatient,,,124,86.8,,99.2,80,,79.36,percent of total Billed Charges,80% of Total Billed Charges,78.12,63,,62.496,percent of total Billed charges,63% of Total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total BIlled charges,78.12,63,,62.496,percent of total Billed Charges,63% of total Billed Charges,105.4,85,,84.32,percent of total Billed Charges,85% of total Billed Charges,99.2,80,,79.36,percent of total Billed Charges,80% of total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total Billed Charges,78.12,63,,62.496,percent of total Billed Charges,63% of total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total Billed Charges,78.12,63,,62.496,percent of total billed charges,63% of total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total Billed Charges,99.2,80,,79.36,percent of total Billed Charges,80% of Total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total Billed Charges,76.88,62,,61.504,percent of total Billed Charges,62% of total Billed Charges,76.88,105.4,
19000 - PUNCTURE ASPIRATION OF CYST OF BREAST; TechFee,220162,CDM,450,RC,19000,HCPCS,Outpatient,,,839,587.3,,671.2,80,,536.96,percent of total Billed Charges,80% of Total Billed Charges,528.57,63,,422.856,percent of total Billed charges,63% of Total Billed Charges,520.18,62,,416.144,percent of total Billed Charges,62% of total BIlled charges,528.57,63,,422.856,percent of total Billed Charges,63% of total Billed Charges,713.15,85,,570.52,percent of total Billed Charges,85% of total Billed Charges,671.2,80,,536.96,percent of total Billed Charges,80% of total Billed Charges,520.18,62,,416.144,percent of total Billed Charges,62% of total Billed Charges,528.57,63,,422.856,percent of total Billed Charges,63% of total Billed Charges,520.18,62,,416.144,percent of total Billed Charges,62% of total Billed Charges,528.57,63,,422.856,percent of total billed charges,63% of total Billed Charges,520.18,62,,416.144,percent of total Billed Charges,62% of total Billed Charges,671.2,80,,536.96,percent of total Billed Charges,80% of Total Billed Charges,520.18,62,,416.144,percent of total Billed Charges,62% of total Billed Charges,520.18,62,,416.144,percent of total Billed Charges,62% of total Billed Charges,520.18,713.15,
20100 - EXPLORATION PENETRATING WOUND SPX NECK TechFee,220091,CDM,450,RC,20100,HCPCS,Outpatient,,,1113,779.1,,890.4,80,,712.32,percent of total Billed Charges,80% of Total Billed Charges,701.19,63,,560.952,percent of total Billed charges,63% of Total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total BIlled charges,701.19,63,,560.952,percent of total Billed Charges,63% of total Billed Charges,946.05,85,,756.84,percent of total Billed Charges,85% of total Billed Charges,890.4,80,,712.32,percent of total Billed Charges,80% of total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total Billed Charges,701.19,63,,560.952,percent of total Billed Charges,63% of total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total Billed Charges,701.19,63,,560.952,percent of total billed charges,63% of total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total Billed Charges,890.4,80,,712.32,percent of total Billed Charges,80% of Total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total Billed Charges,690.06,946.05,
20101 - EXPLORATION PENETRATING WOUND SPX CHEST TechFee,220066,CDM,450,RC,20101,HCPCS,Outpatient,,,2798,1958.6,,2238.4,80,,1790.72,percent of total Billed Charges,80% of Total Billed Charges,1762.74,63,,1410.192,percent of total Billed charges,63% of Total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total BIlled charges,1762.74,63,,1410.192,percent of total Billed Charges,63% of total Billed Charges,2378.3,85,,1902.64,percent of total Billed Charges,85% of total Billed Charges,2238.4,80,,1790.72,percent of total Billed Charges,80% of total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total Billed Charges,1762.74,63,,1410.192,percent of total Billed Charges,63% of total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total Billed Charges,1762.74,63,,1410.192,percent of total billed charges,63% of total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total Billed Charges,2238.4,80,,1790.72,percent of total Billed Charges,80% of Total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total Billed Charges,1734.76,2378.3,
20102 - EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK TechFee,220067,CDM,450,RC,20102,HCPCS,Outpatient,,,2798,1958.6,,2238.4,80,,1790.72,percent of total Billed Charges,80% of Total Billed Charges,1762.74,63,,1410.192,percent of total Billed charges,63% of Total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total BIlled charges,1762.74,63,,1410.192,percent of total Billed Charges,63% of total Billed Charges,2378.3,85,,1902.64,percent of total Billed Charges,85% of total Billed Charges,2238.4,80,,1790.72,percent of total Billed Charges,80% of total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total Billed Charges,1762.74,63,,1410.192,percent of total Billed Charges,63% of total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total Billed Charges,1762.74,63,,1410.192,percent of total billed charges,63% of total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total Billed Charges,2238.4,80,,1790.72,percent of total Billed Charges,80% of Total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total Billed Charges,1734.76,62,,1387.808,percent of total Billed Charges,62% of total Billed Charges,1734.76,2378.3,
20103 - EXPLORATION PENETRATING WOUND SPX EXTREMITY TechFee,220068,CDM,450,RC,20103,HCPCS,Outpatient,,,1724,1206.8,,1379.2,80,,1103.36,percent of total Billed Charges,80% of Total Billed Charges,1086.12,63,,868.896,percent of total Billed charges,63% of Total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total BIlled charges,1086.12,63,,868.896,percent of total Billed Charges,63% of total Billed Charges,1465.4,85,,1172.32,percent of total Billed Charges,85% of total Billed Charges,1379.2,80,,1103.36,percent of total Billed Charges,80% of total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1086.12,63,,868.896,percent of total Billed Charges,63% of total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1086.12,63,,868.896,percent of total billed charges,63% of total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1379.2,80,,1103.36,percent of total Billed Charges,80% of Total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1068.88,62,,855.104,percent of total Billed Charges,62% of total Billed Charges,1068.88,1465.4,
20520 - REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE TechFee,220069,CDM,450,RC,20520,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
20525 - RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP TechFee,220192,CDM,450,RC,20525,HCPCS,Outpatient,,,3543,2480.1,,2834.4,80,,2267.52,percent of total Billed Charges,80% of Total Billed Charges,2232.09,63,,1785.672,percent of total Billed charges,63% of Total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total BIlled charges,2232.09,63,,1785.672,percent of total Billed Charges,63% of total Billed Charges,3011.55,85,,2409.24,percent of total Billed Charges,85% of total Billed Charges,2834.4,80,,2267.52,percent of total Billed Charges,80% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2232.09,63,,1785.672,percent of total Billed Charges,63% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2232.09,63,,1785.672,percent of total billed charges,63% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2834.4,80,,2267.52,percent of total Billed Charges,80% of Total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2196.66,62,,1757.328,percent of total Billed Charges,62% of total Billed Charges,2196.66,3011.55,
20552 - INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES TechFee,220129,CDM,450,RC,20552,HCPCS,Outpatient,,,413,289.1,,330.4,80,,264.32,percent of total Billed Charges,80% of Total Billed Charges,260.19,63,,208.152,percent of total Billed charges,63% of Total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total BIlled charges,260.19,63,,208.152,percent of total Billed Charges,63% of total Billed Charges,351.05,85,,280.84,percent of total Billed Charges,85% of total Billed Charges,330.4,80,,264.32,percent of total Billed Charges,80% of total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,260.19,63,,208.152,percent of total Billed Charges,63% of total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,260.19,63,,208.152,percent of total billed charges,63% of total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,330.4,80,,264.32,percent of total Billed Charges,80% of Total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,256.06,351.05,
20553 - INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES TechFee,220128,CDM,450,RC,20553,HCPCS,Outpatient,,,413,289.1,,330.4,80,,264.32,percent of total Billed Charges,80% of Total Billed Charges,260.19,63,,208.152,percent of total Billed charges,63% of Total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total BIlled charges,260.19,63,,208.152,percent of total Billed Charges,63% of total Billed Charges,351.05,85,,280.84,percent of total Billed Charges,85% of total Billed Charges,330.4,80,,264.32,percent of total Billed Charges,80% of total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,260.19,63,,208.152,percent of total Billed Charges,63% of total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,260.19,63,,208.152,percent of total billed charges,63% of total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,330.4,80,,264.32,percent of total Billed Charges,80% of Total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,256.06,351.05,
20600 - ARTHROCENTESIS ASPIR/INJ SMALL JT/BURSA W/O US TechFee,520600,CDM,450,RC,20600,HCPCS,Outpatient,,,413,289.1,,330.4,80,,264.32,percent of total Billed Charges,80% of Total Billed Charges,260.19,63,,208.152,percent of total Billed charges,63% of Total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total BIlled charges,260.19,63,,208.152,percent of total Billed Charges,63% of total Billed Charges,351.05,85,,280.84,percent of total Billed Charges,85% of total Billed Charges,330.4,80,,264.32,percent of total Billed Charges,80% of total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,260.19,63,,208.152,percent of total Billed Charges,63% of total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,260.19,63,,208.152,percent of total billed charges,63% of total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,330.4,80,,264.32,percent of total Billed Charges,80% of Total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,256.06,351.05,
20605 - ARTHROCENTESIS ASPIR/INJ INTERM JT/BURS W/O US TechFee,520605,CDM,450,RC,20605,HCPCS,Outpatient,,,413,289.1,,330.4,80,,264.32,percent of total Billed Charges,80% of Total Billed Charges,260.19,63,,208.152,percent of total Billed charges,63% of Total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total BIlled charges,260.19,63,,208.152,percent of total Billed Charges,63% of total Billed Charges,351.05,85,,280.84,percent of total Billed Charges,85% of total Billed Charges,330.4,80,,264.32,percent of total Billed Charges,80% of total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,260.19,63,,208.152,percent of total Billed Charges,63% of total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,260.19,63,,208.152,percent of total billed charges,63% of total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,330.4,80,,264.32,percent of total Billed Charges,80% of Total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,256.06,351.05,
20610 - ARTHROCENTESIS ASPIR and/INJ MAJOR JT/BURSA W/O US TechFee,520610,CDM,450,RC,20610,HCPCS,Outpatient,,,413,289.1,,330.4,80,,264.32,percent of total Billed Charges,80% of Total Billed Charges,260.19,63,,208.152,percent of total Billed charges,63% of Total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total BIlled charges,260.19,63,,208.152,percent of total Billed Charges,63% of total Billed Charges,351.05,85,,280.84,percent of total Billed Charges,85% of total Billed Charges,330.4,80,,264.32,percent of total Billed Charges,80% of total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,260.19,63,,208.152,percent of total Billed Charges,63% of total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,260.19,63,,208.152,percent of total billed charges,63% of total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,330.4,80,,264.32,percent of total Billed Charges,80% of Total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,256.06,62,,204.848,percent of total Billed Charges,62% of total Billed Charges,256.06,351.05,
21310 - CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION TechFee,220070,CDM,450,RC,21310,HCPCS,Outpatient,,,172,120.4,,137.6,80,,110.08,percent of total Billed Charges,80% of Total Billed Charges,108.36,63,,86.688,percent of total Billed charges,63% of Total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total BIlled charges,108.36,63,,86.688,percent of total Billed Charges,63% of total Billed Charges,146.2,85,,116.96,percent of total Billed Charges,85% of total Billed Charges,137.6,80,,110.08,percent of total Billed Charges,80% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,108.36,63,,86.688,percent of total Billed Charges,63% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,108.36,63,,86.688,percent of total billed charges,63% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,137.6,80,,110.08,percent of total Billed Charges,80% of Total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,106.64,146.2,
21480 - CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ TechFee,220121,CDM,450,RC,21480,HCPCS,Outpatient,,,172,120.4,,137.6,80,,110.08,percent of total Billed Charges,80% of Total Billed Charges,108.36,63,,86.688,percent of total Billed charges,63% of Total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total BIlled charges,108.36,63,,86.688,percent of total Billed Charges,63% of total Billed Charges,146.2,85,,116.96,percent of total Billed Charges,85% of total Billed Charges,137.6,80,,110.08,percent of total Billed Charges,80% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,108.36,63,,86.688,percent of total Billed Charges,63% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,108.36,63,,86.688,percent of total billed charges,63% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,137.6,80,,110.08,percent of total Billed Charges,80% of Total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,106.64,146.2,
22310 - CLTX VRT BDY FX W/O MANJ REQW/CSTING/BRACING TechFee,220212,CDM,450,RC,22310,HCPCS,Outpatient,,,437,305.9,,349.6,80,,279.68,percent of total Billed Charges,80% of Total Billed Charges,275.31,63,,220.248,percent of total Billed charges,63% of Total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total BIlled charges,275.31,63,,220.248,percent of total Billed Charges,63% of total Billed Charges,371.45,85,,297.16,percent of total Billed Charges,85% of total Billed Charges,349.6,80,,279.68,percent of total Billed Charges,80% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,275.31,63,,220.248,percent of total Billed Charges,63% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,275.31,63,,220.248,percent of total billed charges,63% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,349.6,80,,279.68,percent of total Billed Charges,80% of Total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,270.94,371.45,
23540 - TREAT CLAVICLE DISLOCATION TechFee,220202,CDM,450,RC,23540,HCPCS,Outpatient,,,437,305.9,,349.6,80,,279.68,percent of total Billed Charges,80% of Total Billed Charges,275.31,63,,220.248,percent of total Billed charges,63% of Total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total BIlled charges,275.31,63,,220.248,percent of total Billed Charges,63% of total Billed Charges,371.45,85,,297.16,percent of total Billed Charges,85% of total Billed Charges,349.6,80,,279.68,percent of total Billed Charges,80% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,275.31,63,,220.248,percent of total Billed Charges,63% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,275.31,63,,220.248,percent of total billed charges,63% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,349.6,80,,279.68,percent of total Billed Charges,80% of Total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,270.94,371.45,
23545 - CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION TechFee,523545,CDM,450,RC,23545,HCPCS,Outpatient,,,354,247.8,,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,223.02,63,,178.416,percent of total Billed charges,63% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total BIlled charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,300.9,85,,240.72,percent of total Billed Charges,85% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total billed charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,300.9,
23570 - CLOSED TREATMENT OF SCAPULAR FRACTURE; WITHOUT MANIPULATION TechFee,220213,CDM,450,RC,23570,HCPCS,Outpatient,,,346,242.2,,276.8,80,,221.44,percent of total Billed Charges,80% of Total Billed Charges,217.98,63,,174.384,percent of total Billed charges,63% of Total Billed Charges,214.52,62,,171.616,percent of total Billed Charges,62% of total BIlled charges,217.98,63,,174.384,percent of total Billed Charges,63% of total Billed Charges,294.1,85,,235.28,percent of total Billed Charges,85% of total Billed Charges,276.8,80,,221.44,percent of total Billed Charges,80% of total Billed Charges,214.52,62,,171.616,percent of total Billed Charges,62% of total Billed Charges,217.98,63,,174.384,percent of total Billed Charges,63% of total Billed Charges,214.52,62,,171.616,percent of total Billed Charges,62% of total Billed Charges,217.98,63,,174.384,percent of total billed charges,63% of total Billed Charges,214.52,62,,171.616,percent of total Billed Charges,62% of total Billed Charges,276.8,80,,221.44,percent of total Billed Charges,80% of Total Billed Charges,214.52,62,,171.616,percent of total Billed Charges,62% of total Billed Charges,214.52,62,,171.616,percent of total Billed Charges,62% of total Billed Charges,214.52,294.1,
23650 - CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES TechFee,220152,CDM,450,RC,23650,HCPCS,Outpatient,,,354,247.8,,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,223.02,63,,178.416,percent of total Billed charges,63% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total BIlled charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,300.9,85,,240.72,percent of total Billed Charges,85% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total billed charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,300.9,
23655 - CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES TechFee,220153,CDM,450,RC,23655,HCPCS,Outpatient,,,2355,1648.5,,1884,80,,1507.2,percent of total Billed Charges,80% of Total Billed Charges,1483.65,63,,1186.92,percent of total Billed charges,63% of Total Billed Charges,1460.1,62,,1168.08,percent of total Billed Charges,62% of total BIlled charges,1483.65,63,,1186.92,percent of total Billed Charges,63% of total Billed Charges,2001.75,85,,1601.4,percent of total Billed Charges,85% of total Billed Charges,1884,80,,1507.2,percent of total Billed Charges,80% of total Billed Charges,1460.1,62,,1168.08,percent of total Billed Charges,62% of total Billed Charges,1483.65,63,,1186.92,percent of total Billed Charges,63% of total Billed Charges,1460.1,62,,1168.08,percent of total Billed Charges,62% of total Billed Charges,1483.65,63,,1186.92,percent of total billed charges,63% of total Billed Charges,1460.1,62,,1168.08,percent of total Billed Charges,62% of total Billed Charges,1884,80,,1507.2,percent of total Billed Charges,80% of Total Billed Charges,1460.1,62,,1168.08,percent of total Billed Charges,62% of total Billed Charges,1460.1,62,,1168.08,percent of total Billed Charges,62% of total Billed Charges,1460.1,2001.75,
23930 - ID UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA TechFee,220072,CDM,450,RC,23930,HCPCS,Outpatient,,,1162,813.4,,929.6,80,,743.68,percent of total Billed Charges,80% of Total Billed Charges,732.06,63,,585.648,percent of total Billed charges,63% of Total Billed Charges,720.44,62,,576.352,percent of total Billed Charges,62% of total BIlled charges,732.06,63,,585.648,percent of total Billed Charges,63% of total Billed Charges,987.7,85,,790.16,percent of total Billed Charges,85% of total Billed Charges,929.6,80,,743.68,percent of total Billed Charges,80% of total Billed Charges,720.44,62,,576.352,percent of total Billed Charges,62% of total Billed Charges,732.06,63,,585.648,percent of total Billed Charges,63% of total Billed Charges,720.44,62,,576.352,percent of total Billed Charges,62% of total Billed Charges,732.06,63,,585.648,percent of total billed charges,63% of total Billed Charges,720.44,62,,576.352,percent of total Billed Charges,62% of total Billed Charges,929.6,80,,743.68,percent of total Billed Charges,80% of Total Billed Charges,720.44,62,,576.352,percent of total Billed Charges,62% of total Billed Charges,720.44,62,,576.352,percent of total Billed Charges,62% of total Billed Charges,720.44,987.7,
24505 Treatment closed humeral shaft fracture,524505,CDM,450,RC,24505,HCPCS,Outpatient,,,2870,2009,,2296,80,,1836.8,percent of total Billed Charges,80% of Total Billed Charges,1808.1,63,,1446.48,percent of total Billed charges,63% of Total Billed Charges,1779.4,62,,1423.52,percent of total Billed Charges,62% of total BIlled charges,1808.1,63,,1446.48,percent of total Billed Charges,63% of total Billed Charges,2439.5,85,,1951.6,percent of total Billed Charges,85% of total Billed Charges,2296,80,,1836.8,percent of total Billed Charges,80% of total Billed Charges,1779.4,62,,1423.52,percent of total Billed Charges,62% of total Billed Charges,1808.1,63,,1446.48,percent of total Billed Charges,63% of total Billed Charges,1779.4,62,,1423.52,percent of total Billed Charges,62% of total Billed Charges,1808.1,63,,1446.48,percent of total billed charges,63% of total Billed Charges,1779.4,62,,1423.52,percent of total Billed Charges,62% of total Billed Charges,2296,80,,1836.8,percent of total Billed Charges,80% of Total Billed Charges,1779.4,62,,1423.52,percent of total Billed Charges,62% of total Billed Charges,1779.4,62,,1423.52,percent of total Billed Charges,62% of total Billed Charges,1779.4,2439.5,
24600 - TREATMENT CLOSED ELBOW DISLOCATION W/O ANES TechFee,524600,CDM,450,RC,24600,HCPCS,Outpatient,,,354,247.8,,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,223.02,63,,178.416,percent of total Billed charges,63% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total BIlled charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,300.9,85,,240.72,percent of total Billed Charges,85% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total billed charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,300.9,
24605 - TREATMENT CLOSED ELBOW DISLOCATION REQ ANES TechFee,220143,CDM,450,RC,24605,HCPCS,Outpatient,,,2355,1648.5,,1884,80,,1507.2,percent of total Billed Charges,80% of Total Billed Charges,1483.65,63,,1186.92,percent of total Billed charges,63% of Total Billed Charges,1460.1,62,,1168.08,percent of total Billed Charges,62% of total BIlled charges,1483.65,63,,1186.92,percent of total Billed Charges,63% of total Billed Charges,2001.75,85,,1601.4,percent of total Billed Charges,85% of total Billed Charges,1884,80,,1507.2,percent of total Billed Charges,80% of total Billed Charges,1460.1,62,,1168.08,percent of total Billed Charges,62% of total Billed Charges,1483.65,63,,1186.92,percent of total Billed Charges,63% of total Billed Charges,1460.1,62,,1168.08,percent of total Billed Charges,62% of total Billed Charges,1483.65,63,,1186.92,percent of total billed charges,63% of total Billed Charges,1460.1,62,,1168.08,percent of total Billed Charges,62% of total Billed Charges,1884,80,,1507.2,percent of total Billed Charges,80% of Total Billed Charges,1460.1,62,,1168.08,percent of total Billed Charges,62% of total Billed Charges,1460.1,62,,1168.08,percent of total Billed Charges,62% of total Billed Charges,1460.1,2001.75,
24640 - CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ TechFee,220206,CDM,450,RC,24640,HCPCS,Outpatient,,,437,305.9,,349.6,80,,279.68,percent of total Billed Charges,80% of Total Billed Charges,275.31,63,,220.248,percent of total Billed charges,63% of Total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total BIlled charges,275.31,63,,220.248,percent of total Billed Charges,63% of total Billed Charges,371.45,85,,297.16,percent of total Billed Charges,85% of total Billed Charges,349.6,80,,279.68,percent of total Billed Charges,80% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,275.31,63,,220.248,percent of total Billed Charges,63% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,275.31,63,,220.248,percent of total billed charges,63% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,349.6,80,,279.68,percent of total Billed Charges,80% of Total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,270.94,371.45,
25680 - CLOSED TREATMENTTRANS-SCAPHOPERILUNAR TYPEFRACTURE DISLOC W/ MANIP TechFee,220120,CDM,450,RC,25680,HCPCS,Outpatient,,,221,154.7,,176.8,80,,141.44,percent of total Billed Charges,80% of Total Billed Charges,139.23,63,,111.384,percent of total Billed charges,63% of Total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total BIlled charges,139.23,63,,111.384,percent of total Billed Charges,63% of total Billed Charges,187.85,85,,150.28,percent of total Billed Charges,85% of total Billed Charges,176.8,80,,141.44,percent of total Billed Charges,80% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,139.23,63,,111.384,percent of total Billed Charges,63% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,139.23,63,,111.384,percent of total billed charges,63% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,176.8,80,,141.44,percent of total Billed Charges,80% of Total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,137.02,187.85,
26010 - DRAINAGE FINGER ABSCESS SIMPLE TechFee,526010,CDM,450,RC,26010,HCPCS,Outpatient,,,326,228.2,,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,205.38,63,,164.304,percent of total Billed charges,63% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total BIlled charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,277.1,85,,221.68,percent of total Billed Charges,85% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total billed charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,277.1,
26070 - FOREIGN BODY REMOVAL FROM HAND TechFee,526070,CDM,450,RC,26070,HCPCS,Outpatient,,,2552,1786.4,,2041.6,80,,1633.28,percent of total Billed Charges,80% of Total Billed Charges,1607.76,63,,1286.208,percent of total Billed charges,63% of Total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total BIlled charges,1607.76,63,,1286.208,percent of total Billed Charges,63% of total Billed Charges,2169.2,85,,1735.36,percent of total Billed Charges,85% of total Billed Charges,2041.6,80,,1633.28,percent of total Billed Charges,80% of total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total Billed Charges,1607.76,63,,1286.208,percent of total Billed Charges,63% of total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total Billed Charges,1607.76,63,,1286.208,percent of total billed charges,63% of total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total Billed Charges,2041.6,80,,1633.28,percent of total Billed Charges,80% of Total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total Billed Charges,1582.24,2169.2,
26605 - CLTX METACARPAL FX W/MANIPULATION EACH BONE TechFee,220074,CDM,450,RC,26605,HCPCS,Outpatient,,,354,247.8,,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,223.02,63,,178.416,percent of total Billed charges,63% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total BIlled charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,300.9,85,,240.72,percent of total Billed Charges,85% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total billed charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,300.9,
26641 - CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ TechFee,526641,CDM,450,RC,26641,HCPCS,Outpatient,,,354,247.8,,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,223.02,63,,178.416,percent of total Billed charges,63% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total BIlled charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,300.9,85,,240.72,percent of total Billed Charges,85% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total billed charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,300.9,
26700 - CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES TechFee,220203,CDM,450,RC,26700,HCPCS,Outpatient,,,437,305.9,,349.6,80,,279.68,percent of total Billed Charges,80% of Total Billed Charges,275.31,63,,220.248,percent of total Billed charges,63% of Total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total BIlled charges,275.31,63,,220.248,percent of total Billed Charges,63% of total Billed Charges,371.45,85,,297.16,percent of total Billed Charges,85% of total Billed Charges,349.6,80,,279.68,percent of total Billed Charges,80% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,275.31,63,,220.248,percent of total Billed Charges,63% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,275.31,63,,220.248,percent of total billed charges,63% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,349.6,80,,279.68,percent of total Billed Charges,80% of Total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,270.94,371.45,
26720 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA TechFee,220075,CDM,450,RC,26720,HCPCS,Outpatient,,,221,154.7,,176.8,80,,141.44,percent of total Billed Charges,80% of Total Billed Charges,139.23,63,,111.384,percent of total Billed charges,63% of Total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total BIlled charges,139.23,63,,111.384,percent of total Billed Charges,63% of total Billed Charges,187.85,85,,150.28,percent of total Billed Charges,85% of total Billed Charges,176.8,80,,141.44,percent of total Billed Charges,80% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,139.23,63,,111.384,percent of total Billed Charges,63% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,139.23,63,,111.384,percent of total billed charges,63% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,176.8,80,,141.44,percent of total Billed Charges,80% of Total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,137.02,187.85,
26725 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA TechFee,220076,CDM,450,RC,26725,HCPCS,Outpatient,,,354,247.8,,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,223.02,63,,178.416,percent of total Billed charges,63% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total BIlled charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,300.9,85,,240.72,percent of total Billed Charges,85% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total billed charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,300.9,
26740 - CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ TechFee,220215,CDM,450,RC,26740,HCPCS,Outpatient,,,437,305.9,,349.6,80,,279.68,percent of total Billed Charges,80% of Total Billed Charges,275.31,63,,220.248,percent of total Billed charges,63% of Total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total BIlled charges,275.31,63,,220.248,percent of total Billed Charges,63% of total Billed Charges,371.45,85,,297.16,percent of total Billed Charges,85% of total Billed Charges,349.6,80,,279.68,percent of total Billed Charges,80% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,275.31,63,,220.248,percent of total Billed Charges,63% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,275.31,63,,220.248,percent of total billed charges,63% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,349.6,80,,279.68,percent of total Billed Charges,80% of Total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,270.94,371.45,
26750 - CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA TechFee,220216,CDM,450,RC,26750,HCPCS,Outpatient,,,346,242.2,,276.8,80,,221.44,percent of total Billed Charges,80% of Total Billed Charges,217.98,63,,174.384,percent of total Billed charges,63% of Total Billed Charges,214.52,62,,171.616,percent of total Billed Charges,62% of total BIlled charges,217.98,63,,174.384,percent of total Billed Charges,63% of total Billed Charges,294.1,85,,235.28,percent of total Billed Charges,85% of total Billed Charges,276.8,80,,221.44,percent of total Billed Charges,80% of total Billed Charges,214.52,62,,171.616,percent of total Billed Charges,62% of total Billed Charges,217.98,63,,174.384,percent of total Billed Charges,63% of total Billed Charges,214.52,62,,171.616,percent of total Billed Charges,62% of total Billed Charges,217.98,63,,174.384,percent of total billed charges,63% of total Billed Charges,214.52,62,,171.616,percent of total Billed Charges,62% of total Billed Charges,276.8,80,,221.44,percent of total Billed Charges,80% of Total Billed Charges,214.52,62,,171.616,percent of total Billed Charges,62% of total Billed Charges,214.52,62,,171.616,percent of total Billed Charges,62% of total Billed Charges,214.52,294.1,
26770 - CLTX IPHAL JT DISLC W/MANJ W/O ANES TechFee,220109,CDM,450,RC,26770,HCPCS,Outpatient,,,221,154.7,,176.8,80,,141.44,percent of total Billed Charges,80% of Total Billed Charges,139.23,63,,111.384,percent of total Billed charges,63% of Total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total BIlled charges,139.23,63,,111.384,percent of total Billed Charges,63% of total Billed Charges,187.85,85,,150.28,percent of total Billed Charges,85% of total Billed Charges,176.8,80,,141.44,percent of total Billed Charges,80% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,139.23,63,,111.384,percent of total Billed Charges,63% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,139.23,63,,111.384,percent of total billed charges,63% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,176.8,80,,141.44,percent of total Billed Charges,80% of Total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,137.02,187.85,
26951 - AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR TechFee,220119,CDM,450,RC,26951,HCPCS,Outpatient,,,2552,1786.4,,2041.6,80,,1633.28,percent of total Billed Charges,80% of Total Billed Charges,1607.76,63,,1286.208,percent of total Billed charges,63% of Total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total BIlled charges,1607.76,63,,1286.208,percent of total Billed Charges,63% of total Billed Charges,2169.2,85,,1735.36,percent of total Billed Charges,85% of total Billed Charges,2041.6,80,,1633.28,percent of total Billed Charges,80% of total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total Billed Charges,1607.76,63,,1286.208,percent of total Billed Charges,63% of total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total Billed Charges,1607.76,63,,1286.208,percent of total billed charges,63% of total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total Billed Charges,2041.6,80,,1633.28,percent of total Billed Charges,80% of Total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total Billed Charges,1582.24,62,,1265.792,percent of total Billed Charges,62% of total Billed Charges,1582.24,2169.2,
26990 - INCISION AND DRAINAGE PELVIS HIP JOINT AREA; DEEP ABSCESS HEMATOMA TechFee,220107,CDM,450,RC,26990,HCPCS,Outpatient,,,3345,2341.5,,2676,80,,2140.8,percent of total Billed Charges,80% of Total Billed Charges,2107.35,63,,1685.88,percent of total Billed charges,63% of Total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total BIlled charges,2107.35,63,,1685.88,percent of total Billed Charges,63% of total Billed Charges,2843.25,85,,2274.6,percent of total Billed Charges,85% of total Billed Charges,2676,80,,2140.8,percent of total Billed Charges,80% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2107.35,63,,1685.88,percent of total Billed Charges,63% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2107.35,63,,1685.88,percent of total billed charges,63% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2676,80,,2140.8,percent of total Billed Charges,80% of Total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2073.9,62,,1659.12,percent of total Billed Charges,62% of total Billed Charges,2073.9,2843.25,
27250 - CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA TechFee,220155,CDM,450,RC,27250,HCPCS,Outpatient,,,354,247.8,,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,223.02,63,,178.416,percent of total Billed charges,63% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total BIlled charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,300.9,85,,240.72,percent of total Billed Charges,85% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total billed charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,300.9,
27252 - CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA TechFee,220166,CDM,450,RC,27252,HCPCS,Outpatient,,,916,641.2,,732.8,80,,586.24,percent of total Billed Charges,80% of Total Billed Charges,577.08,63,,461.664,percent of total Billed charges,63% of Total Billed Charges,567.92,62,,454.336,percent of total Billed Charges,62% of total BIlled charges,577.08,63,,461.664,percent of total Billed Charges,63% of total Billed Charges,778.6,85,,622.88,percent of total Billed Charges,85% of total Billed Charges,732.8,80,,586.24,percent of total Billed Charges,80% of total Billed Charges,567.92,62,,454.336,percent of total Billed Charges,62% of total Billed Charges,577.08,63,,461.664,percent of total Billed Charges,63% of total Billed Charges,567.92,62,,454.336,percent of total Billed Charges,62% of total Billed Charges,577.08,63,,461.664,percent of total billed charges,63% of total Billed Charges,567.92,62,,454.336,percent of total Billed Charges,62% of total Billed Charges,732.8,80,,586.24,percent of total Billed Charges,80% of Total Billed Charges,567.92,62,,454.336,percent of total Billed Charges,62% of total Billed Charges,567.92,62,,454.336,percent of total Billed Charges,62% of total Billed Charges,567.92,778.6,
27550 - CLOSED TX KNEE DISLOCATION W/O ANESTHESIA TechFee,527550,CDM,450,RC,27550,HCPCS,Outpatient,,,354,247.8,,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,223.02,63,,178.416,percent of total Billed charges,63% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total BIlled charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,300.9,85,,240.72,percent of total Billed Charges,85% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total billed charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,300.9,
27552 - CL TX KNEE DISLOC + ANES TechFee,220154,CDM,450,RC,27552,HCPCS,Outpatient,,,2355,1648.5,,1884,80,,1507.2,percent of total Billed Charges,80% of Total Billed Charges,1483.65,63,,1186.92,percent of total Billed charges,63% of Total Billed Charges,1460.1,62,,1168.08,percent of total Billed Charges,62% of total BIlled charges,1483.65,63,,1186.92,percent of total Billed Charges,63% of total Billed Charges,2001.75,85,,1601.4,percent of total Billed Charges,85% of total Billed Charges,1884,80,,1507.2,percent of total Billed Charges,80% of total Billed Charges,1460.1,62,,1168.08,percent of total Billed Charges,62% of total Billed Charges,1483.65,63,,1186.92,percent of total Billed Charges,63% of total Billed Charges,1460.1,62,,1168.08,percent of total Billed Charges,62% of total Billed Charges,1483.65,63,,1186.92,percent of total billed charges,63% of total Billed Charges,1460.1,62,,1168.08,percent of total Billed Charges,62% of total Billed Charges,1884,80,,1507.2,percent of total Billed Charges,80% of Total Billed Charges,1460.1,62,,1168.08,percent of total Billed Charges,62% of total Billed Charges,1460.1,62,,1168.08,percent of total Billed Charges,62% of total Billed Charges,1460.1,2001.75,
27560 - CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA TechFee,220205,CDM,450,RC,27560,HCPCS,Outpatient,,,346,242.2,,276.8,80,,221.44,percent of total Billed Charges,80% of Total Billed Charges,217.98,63,,174.384,percent of total Billed charges,63% of Total Billed Charges,214.52,62,,171.616,percent of total Billed Charges,62% of total BIlled charges,217.98,63,,174.384,percent of total Billed Charges,63% of total Billed Charges,294.1,85,,235.28,percent of total Billed Charges,85% of total Billed Charges,276.8,80,,221.44,percent of total Billed Charges,80% of total Billed Charges,214.52,62,,171.616,percent of total Billed Charges,62% of total Billed Charges,217.98,63,,174.384,percent of total Billed Charges,63% of total Billed Charges,214.52,62,,171.616,percent of total Billed Charges,62% of total Billed Charges,217.98,63,,174.384,percent of total billed charges,63% of total Billed Charges,214.52,62,,171.616,percent of total Billed Charges,62% of total Billed Charges,276.8,80,,221.44,percent of total Billed Charges,80% of Total Billed Charges,214.52,62,,171.616,percent of total Billed Charges,62% of total Billed Charges,214.52,62,,171.616,percent of total Billed Charges,62% of total Billed Charges,214.52,294.1,
27786 - CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ TechFee,220101,CDM,450,RC,27786,HCPCS,Outpatient,,,354,247.8,,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,223.02,63,,178.416,percent of total Billed charges,63% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total BIlled charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,300.9,85,,240.72,percent of total Billed Charges,85% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total billed charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,300.9,
27788 - CLTX DSTL FIBULAR FX LAT MALLS W/MANJ TechFee,220122,CDM,450,RC,27788,HCPCS,Outpatient,,,354,247.8,,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,223.02,63,,178.416,percent of total Billed charges,63% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total BIlled charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,300.9,85,,240.72,percent of total Billed Charges,85% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total billed charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,300.9,
28190 - REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS TechFee,220077,CDM,450,RC,28190,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
28192 - REMOVAL FOREIGN BODY FOOT DEEP TechFee,220078,CDM,450,RC,28192,HCPCS,Outpatient,,,2339,1637.3,,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1473.57,63,,1178.856,percent of total Billed charges,63% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total BIlled charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1988.15,85,,1590.52,percent of total Billed Charges,85% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total Billed Charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1473.57,63,,1178.856,percent of total billed charges,63% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1871.2,80,,1496.96,percent of total Billed Charges,80% of Total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,62,,1160.144,percent of total Billed Charges,62% of total Billed Charges,1450.18,1988.15,
28470 - CLOSED TX METATARSAL FRACTURE W/O MANIPULATION TechFee,220217,CDM,450,RC,28470,HCPCS,Outpatient,,,437,305.9,,349.6,80,,279.68,percent of total Billed Charges,80% of Total Billed Charges,275.31,63,,220.248,percent of total Billed charges,63% of Total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total BIlled charges,275.31,63,,220.248,percent of total Billed Charges,63% of total Billed Charges,371.45,85,,297.16,percent of total Billed Charges,85% of total Billed Charges,349.6,80,,279.68,percent of total Billed Charges,80% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,275.31,63,,220.248,percent of total Billed Charges,63% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,275.31,63,,220.248,percent of total billed charges,63% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,349.6,80,,279.68,percent of total Billed Charges,80% of Total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,270.94,371.45,
28490 - CLTX FX GRT TOE PHLX/PHLG W/O MANJ TechFee,220053,CDM,450,RC,28490,HCPCS,Outpatient,,,221,154.7,,176.8,80,,141.44,percent of total Billed Charges,80% of Total Billed Charges,139.23,63,,111.384,percent of total Billed charges,63% of Total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total BIlled charges,139.23,63,,111.384,percent of total Billed Charges,63% of total Billed Charges,187.85,85,,150.28,percent of total Billed Charges,85% of total Billed Charges,176.8,80,,141.44,percent of total Billed Charges,80% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,139.23,63,,111.384,percent of total Billed Charges,63% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,139.23,63,,111.384,percent of total billed charges,63% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,176.8,80,,141.44,percent of total Billed Charges,80% of Total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,137.02,187.85,
28495 - CLTX FX GRT TOE PHLX/PHLG W/MANJ TechFee,220218,CDM,450,RC,28495,HCPCS,Outpatient,,,437,305.9,,349.6,80,,279.68,percent of total Billed Charges,80% of Total Billed Charges,275.31,63,,220.248,percent of total Billed charges,63% of Total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total BIlled charges,275.31,63,,220.248,percent of total Billed Charges,63% of total Billed Charges,371.45,85,,297.16,percent of total Billed Charges,85% of total Billed Charges,349.6,80,,279.68,percent of total Billed Charges,80% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,275.31,63,,220.248,percent of total Billed Charges,63% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,275.31,63,,220.248,percent of total billed charges,63% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,349.6,80,,279.68,percent of total Billed Charges,80% of Total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,270.94,371.45,
28510 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ TechFee,220054,CDM,450,RC,28510,HCPCS,Outpatient,,,221,154.7,,176.8,80,,141.44,percent of total Billed Charges,80% of Total Billed Charges,139.23,63,,111.384,percent of total Billed charges,63% of Total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total BIlled charges,139.23,63,,111.384,percent of total Billed Charges,63% of total Billed Charges,187.85,85,,150.28,percent of total Billed Charges,85% of total Billed Charges,176.8,80,,141.44,percent of total Billed Charges,80% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,139.23,63,,111.384,percent of total Billed Charges,63% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,139.23,63,,111.384,percent of total billed charges,63% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,176.8,80,,141.44,percent of total Billed Charges,80% of Total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,137.02,187.85,
28515 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ TechFee,220055,CDM,450,RC,28515,HCPCS,Outpatient,,,354,247.8,,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,223.02,63,,178.416,percent of total Billed charges,63% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total BIlled charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,300.9,85,,240.72,percent of total Billed Charges,85% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total Billed Charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,223.02,63,,178.416,percent of total billed charges,63% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,283.2,80,,226.56,percent of total Billed Charges,80% of Total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,62,,175.584,percent of total Billed Charges,62% of total Billed Charges,219.48,300.9,
28630 - CLTX METATARSOPHLNGL JT DISLC W/O ANES TechFee,220204,CDM,450,RC,28630,HCPCS,Outpatient,,,437,305.9,,349.6,80,,279.68,percent of total Billed Charges,80% of Total Billed Charges,275.31,63,,220.248,percent of total Billed charges,63% of Total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total BIlled charges,275.31,63,,220.248,percent of total Billed Charges,63% of total Billed Charges,371.45,85,,297.16,percent of total Billed Charges,85% of total Billed Charges,349.6,80,,279.68,percent of total Billed Charges,80% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,275.31,63,,220.248,percent of total Billed Charges,63% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,275.31,63,,220.248,percent of total billed charges,63% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,349.6,80,,279.68,percent of total Billed Charges,80% of Total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,270.94,62,,216.752,percent of total Billed Charges,62% of total Billed Charges,270.94,371.45,
28660 - CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES TechFee,220130,CDM,450,RC,28660,HCPCS,Outpatient,,,221,154.7,,176.8,80,,141.44,percent of total Billed Charges,80% of Total Billed Charges,139.23,63,,111.384,percent of total Billed charges,63% of Total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total BIlled charges,139.23,63,,111.384,percent of total Billed Charges,63% of total Billed Charges,187.85,85,,150.28,percent of total Billed Charges,85% of total Billed Charges,176.8,80,,141.44,percent of total Billed Charges,80% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,139.23,63,,111.384,percent of total Billed Charges,63% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,139.23,63,,111.384,percent of total billed charges,63% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,176.8,80,,141.44,percent of total Billed Charges,80% of Total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,137.02,62,,109.616,percent of total Billed Charges,62% of total Billed Charges,137.02,187.85,
28665 - Closed treatment of interphalangeal joint dislocation; requiring anesthesia TechFee,220306,CDM,450,RC,28665,HCPCS,Outpatient,,,472,330.4,,377.6,80,,302.08,percent of total Billed Charges,80% of Total Billed Charges,297.36,63,,237.888,percent of total Billed charges,63% of Total Billed Charges,292.64,62,,234.112,percent of total Billed Charges,62% of total BIlled charges,297.36,63,,237.888,percent of total Billed Charges,63% of total Billed Charges,401.2,85,,320.96,percent of total Billed Charges,85% of total Billed Charges,377.6,80,,302.08,percent of total Billed Charges,80% of total Billed Charges,292.64,62,,234.112,percent of total Billed Charges,62% of total Billed Charges,297.36,63,,237.888,percent of total Billed Charges,63% of total Billed Charges,292.64,62,,234.112,percent of total Billed Charges,62% of total Billed Charges,297.36,63,,237.888,percent of total billed charges,63% of total Billed Charges,292.64,62,,234.112,percent of total Billed Charges,62% of total Billed Charges,377.6,80,,302.08,percent of total Billed Charges,80% of Total Billed Charges,292.64,62,,234.112,percent of total Billed Charges,62% of total Billed Charges,292.64,62,,234.112,percent of total Billed Charges,62% of total Billed Charges,292.64,401.2,
29105 - APPLICATION LONG ARM SPLINT SHOULDER HAND TechFee,220156,CDM,450,RC,29105,HCPCS,Outpatient,,,205,143.5,,164,80,,131.2,percent of total Billed Charges,80% of Total Billed Charges,129.15,63,,103.32,percent of total Billed charges,63% of Total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total BIlled charges,129.15,63,,103.32,percent of total Billed Charges,63% of total Billed Charges,174.25,85,,139.4,percent of total Billed Charges,85% of total Billed Charges,164,80,,131.2,percent of total Billed Charges,80% of total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total Billed Charges,129.15,63,,103.32,percent of total Billed Charges,63% of total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total Billed Charges,129.15,63,,103.32,percent of total billed charges,63% of total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total Billed Charges,164,80,,131.2,percent of total Billed Charges,80% of Total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total Billed Charges,127.1,174.25,
29125 - APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC TechFee,220110,CDM,450,RC,29125,HCPCS,Outpatient,,,205,143.5,,164,80,,131.2,percent of total Billed Charges,80% of Total Billed Charges,129.15,63,,103.32,percent of total Billed charges,63% of Total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total BIlled charges,129.15,63,,103.32,percent of total Billed Charges,63% of total Billed Charges,174.25,85,,139.4,percent of total Billed Charges,85% of total Billed Charges,164,80,,131.2,percent of total Billed Charges,80% of total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total Billed Charges,129.15,63,,103.32,percent of total Billed Charges,63% of total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total Billed Charges,129.15,63,,103.32,percent of total billed charges,63% of total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total Billed Charges,164,80,,131.2,percent of total Billed Charges,80% of Total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total Billed Charges,127.1,174.25,
29130 - APPLICATION FINGER SPLINT STATIC TechFee,220133,CDM,450,RC,29130,HCPCS,Outpatient,,,114,79.8,,91.2,80,,72.96,percent of total Billed Charges,80% of Total Billed Charges,71.82,63,,57.456,percent of total Billed charges,63% of Total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total BIlled charges,71.82,63,,57.456,percent of total Billed Charges,63% of total Billed Charges,96.9,85,,77.52,percent of total Billed Charges,85% of total Billed Charges,91.2,80,,72.96,percent of total Billed Charges,80% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,71.82,63,,57.456,percent of total Billed Charges,63% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,71.82,63,,57.456,percent of total billed charges,63% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,91.2,80,,72.96,percent of total Billed Charges,80% of Total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,70.68,96.9,
29200 - STRAPPING; THORAX TechFee,220134,CDM,450,RC,29200,HCPCS,Outpatient,,,114,79.8,,91.2,80,,72.96,percent of total Billed Charges,80% of Total Billed Charges,71.82,63,,57.456,percent of total Billed charges,63% of Total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total BIlled charges,71.82,63,,57.456,percent of total Billed Charges,63% of total Billed Charges,96.9,85,,77.52,percent of total Billed Charges,85% of total Billed Charges,91.2,80,,72.96,percent of total Billed Charges,80% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,71.82,63,,57.456,percent of total Billed Charges,63% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,71.82,63,,57.456,percent of total billed charges,63% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,91.2,80,,72.96,percent of total Billed Charges,80% of Total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,70.68,96.9,
29240 - STRAPPING SHOULDER TechFee,220111,CDM,450,RC,29240,HCPCS,Outpatient,,,114,79.8,,91.2,80,,72.96,percent of total Billed Charges,80% of Total Billed Charges,71.82,63,,57.456,percent of total Billed charges,63% of Total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total BIlled charges,71.82,63,,57.456,percent of total Billed Charges,63% of total Billed Charges,96.9,85,,77.52,percent of total Billed Charges,85% of total Billed Charges,91.2,80,,72.96,percent of total Billed Charges,80% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,71.82,63,,57.456,percent of total Billed Charges,63% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,71.82,63,,57.456,percent of total billed charges,63% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,91.2,80,,72.96,percent of total Billed Charges,80% of Total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,70.68,96.9,
29260 - STRAPPING ELBOW/WRIST TechFee,220112,CDM,450,RC,29260,HCPCS,Outpatient,,,114,79.8,,91.2,80,,72.96,percent of total Billed Charges,80% of Total Billed Charges,71.82,63,,57.456,percent of total Billed charges,63% of Total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total BIlled charges,71.82,63,,57.456,percent of total Billed Charges,63% of total Billed Charges,96.9,85,,77.52,percent of total Billed Charges,85% of total Billed Charges,91.2,80,,72.96,percent of total Billed Charges,80% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,71.82,63,,57.456,percent of total Billed Charges,63% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,71.82,63,,57.456,percent of total billed charges,63% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,91.2,80,,72.96,percent of total Billed Charges,80% of Total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,70.68,96.9,
29280 - STRAPPING HAND/FINGER TechFee,220113,CDM,450,RC,29280,HCPCS,Outpatient,,,114,79.8,,91.2,80,,72.96,percent of total Billed Charges,80% of Total Billed Charges,71.82,63,,57.456,percent of total Billed charges,63% of Total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total BIlled charges,71.82,63,,57.456,percent of total Billed Charges,63% of total Billed Charges,96.9,85,,77.52,percent of total Billed Charges,85% of total Billed Charges,91.2,80,,72.96,percent of total Billed Charges,80% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,71.82,63,,57.456,percent of total Billed Charges,63% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,71.82,63,,57.456,percent of total billed charges,63% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,91.2,80,,72.96,percent of total Billed Charges,80% of Total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,70.68,96.9,
29505 - APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES TechFee,220114,CDM,450,RC,29505,HCPCS,Outpatient,,,205,143.5,,164,80,,131.2,percent of total Billed Charges,80% of Total Billed Charges,129.15,63,,103.32,percent of total Billed charges,63% of Total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total BIlled charges,129.15,63,,103.32,percent of total Billed Charges,63% of total Billed Charges,174.25,85,,139.4,percent of total Billed Charges,85% of total Billed Charges,164,80,,131.2,percent of total Billed Charges,80% of total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total Billed Charges,129.15,63,,103.32,percent of total Billed Charges,63% of total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total Billed Charges,129.15,63,,103.32,percent of total billed charges,63% of total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total Billed Charges,164,80,,131.2,percent of total Billed Charges,80% of Total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total Billed Charges,127.1,174.25,
29515 - APPLICATION SHORT LEG SPLINT CALF FOOT TechFee,220106,CDM,450,RC,29515,HCPCS,Outpatient,,,205,143.5,,164,80,,131.2,percent of total Billed Charges,80% of Total Billed Charges,129.15,63,,103.32,percent of total Billed charges,63% of Total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total BIlled charges,129.15,63,,103.32,percent of total Billed Charges,63% of total Billed Charges,174.25,85,,139.4,percent of total Billed Charges,85% of total Billed Charges,164,80,,131.2,percent of total Billed Charges,80% of total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total Billed Charges,129.15,63,,103.32,percent of total Billed Charges,63% of total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total Billed Charges,129.15,63,,103.32,percent of total billed charges,63% of total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total Billed Charges,164,80,,131.2,percent of total Billed Charges,80% of Total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total Billed Charges,127.1,62,,101.68,percent of total Billed Charges,62% of total Billed Charges,127.1,174.25,
29530 - STRAPPING KNEE TechFee,220117,CDM,450,RC,29530,HCPCS,Outpatient,,,112,78.4,,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,70.56,63,,56.448,percent of total Billed charges,63% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total BIlled charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,95.2,85,,76.16,percent of total Billed Charges,85% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total billed charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,95.2,
29540 - STRAPPING ANKLE /FOOT TechFee,220115,CDM,450,RC,29540,HCPCS,Outpatient,,,114,79.8,,91.2,80,,72.96,percent of total Billed Charges,80% of Total Billed Charges,71.82,63,,57.456,percent of total Billed charges,63% of Total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total BIlled charges,71.82,63,,57.456,percent of total Billed Charges,63% of total Billed Charges,96.9,85,,77.52,percent of total Billed Charges,85% of total Billed Charges,91.2,80,,72.96,percent of total Billed Charges,80% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,71.82,63,,57.456,percent of total Billed Charges,63% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,71.82,63,,57.456,percent of total billed charges,63% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,91.2,80,,72.96,percent of total Billed Charges,80% of Total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,70.68,96.9,
29550 - STRAPPING TOES TechFee,220116,CDM,450,RC,29550,HCPCS,Outpatient,,,114,79.8,,91.2,80,,72.96,percent of total Billed Charges,80% of Total Billed Charges,71.82,63,,57.456,percent of total Billed charges,63% of Total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total BIlled charges,71.82,63,,57.456,percent of total Billed Charges,63% of total Billed Charges,96.9,85,,77.52,percent of total Billed Charges,85% of total Billed Charges,91.2,80,,72.96,percent of total Billed Charges,80% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,71.82,63,,57.456,percent of total Billed Charges,63% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,71.82,63,,57.456,percent of total billed charges,63% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,91.2,80,,72.96,percent of total Billed Charges,80% of Total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,70.68,62,,56.544,percent of total Billed Charges,62% of total Billed Charges,70.68,96.9,
29580 - STRAPPING UNNA BOOT TechFee,220219,CDM,450,RC,29580,HCPCS,Outpatient,,,261,182.7,,208.8,80,,167.04,percent of total Billed Charges,80% of Total Billed Charges,164.43,63,,131.544,percent of total Billed charges,63% of Total Billed Charges,161.82,62,,129.456,percent of total Billed Charges,62% of total BIlled charges,164.43,63,,131.544,percent of total Billed Charges,63% of total Billed Charges,221.85,85,,177.48,percent of total Billed Charges,85% of total Billed Charges,208.8,80,,167.04,percent of total Billed Charges,80% of total Billed Charges,161.82,62,,129.456,percent of total Billed Charges,62% of total Billed Charges,164.43,63,,131.544,percent of total Billed Charges,63% of total Billed Charges,161.82,62,,129.456,percent of total Billed Charges,62% of total Billed Charges,164.43,63,,131.544,percent of total billed charges,63% of total Billed Charges,161.82,62,,129.456,percent of total Billed Charges,62% of total Billed Charges,208.8,80,,167.04,percent of total Billed Charges,80% of Total Billed Charges,161.82,62,,129.456,percent of total Billed Charges,62% of total Billed Charges,161.82,62,,129.456,percent of total Billed Charges,62% of total Billed Charges,161.82,221.85,
30300 - FB REMOVAL NOSE TechFee,220056,CDM,450,RC,30300,HCPCS,Outpatient,,,201,140.7,,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,126.63,63,,101.304,percent of total Billed charges,63% of Total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total BIlled charges,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,170.85,85,,136.68,percent of total Billed Charges,85% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,126.63,63,,101.304,percent of total billed charges,63% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,124.62,170.85,
30901 - NASAL PACK/CAUTERY SIMPL TechFee,220051,CDM,450,RC,30901,HCPCS,Outpatient,,,172,120.4,,137.6,80,,110.08,percent of total Billed Charges,80% of Total Billed Charges,108.36,63,,86.688,percent of total Billed charges,63% of Total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total BIlled charges,108.36,63,,86.688,percent of total Billed Charges,63% of total Billed Charges,146.2,85,,116.96,percent of total Billed Charges,85% of total Billed Charges,137.6,80,,110.08,percent of total Billed Charges,80% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,108.36,63,,86.688,percent of total Billed Charges,63% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,108.36,63,,86.688,percent of total billed charges,63% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,137.6,80,,110.08,percent of total Billed Charges,80% of Total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,106.64,146.2,
30903 - NASAL PACK ANT COMP ROCKT TechFee,220052,CDM,450,RC,30903,HCPCS,Outpatient,,,172,120.4,,137.6,80,,110.08,percent of total Billed Charges,80% of Total Billed Charges,108.36,63,,86.688,percent of total Billed charges,63% of Total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total BIlled charges,108.36,63,,86.688,percent of total Billed Charges,63% of total Billed Charges,146.2,85,,116.96,percent of total Billed Charges,85% of total Billed Charges,137.6,80,,110.08,percent of total Billed Charges,80% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,108.36,63,,86.688,percent of total Billed Charges,63% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,108.36,63,,86.688,percent of total billed charges,63% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,137.6,80,,110.08,percent of total Billed Charges,80% of Total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,106.64,146.2,
30905 - NASAL HEM CONT POSTANT TechFee,220193,CDM,450,RC,30905,HCPCS,Outpatient,,,172,120.4,,137.6,80,,110.08,percent of total Billed Charges,80% of Total Billed Charges,108.36,63,,86.688,percent of total Billed charges,63% of Total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total BIlled charges,108.36,63,,86.688,percent of total Billed Charges,63% of total Billed Charges,146.2,85,,116.96,percent of total Billed Charges,85% of total Billed Charges,137.6,80,,110.08,percent of total Billed Charges,80% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,108.36,63,,86.688,percent of total Billed Charges,63% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,108.36,63,,86.688,percent of total billed charges,63% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,137.6,80,,110.08,percent of total Billed Charges,80% of Total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,106.64,146.2,
30906 - CNTRL NOSEBLEED-SUBS ED Tech Fee,220208,CDM,450,RC,30906,HCPCS,Outpatient,,,265,185.5,,212,80,,169.6,percent of total Billed Charges,80% of Total Billed Charges,166.95,63,,133.56,percent of total Billed charges,63% of Total Billed Charges,164.3,62,,131.44,percent of total Billed Charges,62% of total BIlled charges,166.95,63,,133.56,percent of total Billed Charges,63% of total Billed Charges,225.25,85,,180.2,percent of total Billed Charges,85% of total Billed Charges,212,80,,169.6,percent of total Billed Charges,80% of total Billed Charges,164.3,62,,131.44,percent of total Billed Charges,62% of total Billed Charges,166.95,63,,133.56,percent of total Billed Charges,63% of total Billed Charges,164.3,62,,131.44,percent of total Billed Charges,62% of total Billed Charges,166.95,63,,133.56,percent of total billed charges,63% of total Billed Charges,164.3,62,,131.44,percent of total Billed Charges,62% of total Billed Charges,212,80,,169.6,percent of total Billed Charges,80% of Total Billed Charges,164.3,62,,131.44,percent of total Billed Charges,62% of total Billed Charges,164.3,62,,131.44,percent of total Billed Charges,62% of total Billed Charges,164.3,225.25,
31500 - INTUBATION/ET TUBE INSERT TechFee,220079,CDM,450,RC,31500,HCPCS,Outpatient,,,326,228.2,,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,205.38,63,,164.304,percent of total Billed charges,63% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total BIlled charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,277.1,85,,221.68,percent of total Billed Charges,85% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total billed charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,277.1,
31505 - DIAGNOSTIC LARYNGOSC ED Tech Fee,220209,CDM,450,RC,31505,HCPCS,Outpatient,,,308,215.6,,246.4,80,,197.12,percent of total Billed Charges,80% of Total Billed Charges,194.04,63,,155.232,percent of total Billed charges,63% of Total Billed Charges,190.96,62,,152.768,percent of total Billed Charges,62% of total BIlled charges,194.04,63,,155.232,percent of total Billed Charges,63% of total Billed Charges,261.8,85,,209.44,percent of total Billed Charges,85% of total Billed Charges,246.4,80,,197.12,percent of total Billed Charges,80% of total Billed Charges,190.96,62,,152.768,percent of total Billed Charges,62% of total Billed Charges,194.04,63,,155.232,percent of total Billed Charges,63% of total Billed Charges,190.96,62,,152.768,percent of total Billed Charges,62% of total Billed Charges,194.04,63,,155.232,percent of total billed charges,63% of total Billed Charges,190.96,62,,152.768,percent of total Billed Charges,62% of total Billed Charges,246.4,80,,197.12,percent of total Billed Charges,80% of Total Billed Charges,190.96,62,,152.768,percent of total Billed Charges,62% of total Billed Charges,190.96,62,,152.768,percent of total Billed Charges,62% of total Billed Charges,190.96,261.8,
31603 - INCISION OF WINDPIPE ED Tech Fee,220057,CDM,450,RC,31603,HCPCS,Outpatient,,,1113,779.1,,890.4,80,,712.32,percent of total Billed Charges,80% of Total Billed Charges,701.19,63,,560.952,percent of total Billed charges,63% of Total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total BIlled charges,701.19,63,,560.952,percent of total Billed Charges,63% of total Billed Charges,946.05,85,,756.84,percent of total Billed Charges,85% of total Billed Charges,890.4,80,,712.32,percent of total Billed Charges,80% of total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total Billed Charges,701.19,63,,560.952,percent of total Billed Charges,63% of total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total Billed Charges,701.19,63,,560.952,percent of total billed charges,63% of total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total Billed Charges,890.4,80,,712.32,percent of total Billed Charges,80% of Total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total Billed Charges,690.06,946.05,
31605 - TRACHEOSTOMY -CRICOT ED Tech Fee,220058,CDM,450,RC,31605,HCPCS,Outpatient,,,1113,779.1,,890.4,80,,712.32,percent of total Billed Charges,80% of Total Billed Charges,701.19,63,,560.952,percent of total Billed charges,63% of Total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total BIlled charges,701.19,63,,560.952,percent of total Billed Charges,63% of total Billed Charges,946.05,85,,756.84,percent of total Billed Charges,85% of total Billed Charges,890.4,80,,712.32,percent of total Billed Charges,80% of total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total Billed Charges,701.19,63,,560.952,percent of total Billed Charges,63% of total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total Billed Charges,701.19,63,,560.952,percent of total billed charges,63% of total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total Billed Charges,890.4,80,,712.32,percent of total Billed Charges,80% of Total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total Billed Charges,690.06,946.05,
32551 - CHEST TUBE  PLACEMENT TechFee,220059,CDM,450,RC,32551,HCPCS,Outpatient,,,990,693,,792,80,,633.6,percent of total Billed Charges,80% of Total Billed Charges,623.7,63,,498.96,percent of total Billed charges,63% of Total Billed Charges,613.8,62,,491.04,percent of total Billed Charges,62% of total BIlled charges,623.7,63,,498.96,percent of total Billed Charges,63% of total Billed Charges,841.5,85,,673.2,percent of total Billed Charges,85% of total Billed Charges,792,80,,633.6,percent of total Billed Charges,80% of total Billed Charges,613.8,62,,491.04,percent of total Billed Charges,62% of total Billed Charges,623.7,63,,498.96,percent of total Billed Charges,63% of total Billed Charges,613.8,62,,491.04,percent of total Billed Charges,62% of total Billed Charges,623.7,63,,498.96,percent of total billed charges,63% of total Billed Charges,613.8,62,,491.04,percent of total Billed Charges,62% of total Billed Charges,792,80,,633.6,percent of total Billed Charges,80% of Total Billed Charges,613.8,62,,491.04,percent of total Billed Charges,62% of total Billed Charges,613.8,62,,491.04,percent of total Billed Charges,62% of total Billed Charges,613.8,841.5,
32556 - PERQ DRAINAGE PLEURA INSERT CATH W/O IMAGING TechFee,10107,CDM,450,RC,32556,HCPCS,Outpatient,,,3318,2322.6,,2654.4,80,,2123.52,percent of total Billed Charges,80% of Total Billed Charges,2090.34,63,,1672.272,percent of total Billed charges,63% of Total Billed Charges,2057.16,62,,1645.728,percent of total Billed Charges,62% of total BIlled charges,2090.34,63,,1672.272,percent of total Billed Charges,63% of total Billed Charges,2820.3,85,,2256.24,percent of total Billed Charges,85% of total Billed Charges,2654.4,80,,2123.52,percent of total Billed Charges,80% of total Billed Charges,2057.16,62,,1645.728,percent of total Billed Charges,62% of total Billed Charges,2090.34,63,,1672.272,percent of total Billed Charges,63% of total Billed Charges,2057.16,62,,1645.728,percent of total Billed Charges,62% of total Billed Charges,2090.34,63,,1672.272,percent of total billed charges,63% of total Billed Charges,2057.16,62,,1645.728,percent of total Billed Charges,62% of total Billed Charges,2654.4,80,,2123.52,percent of total Billed Charges,80% of Total Billed Charges,2057.16,62,,1645.728,percent of total Billed Charges,62% of total Billed Charges,2057.16,62,,1645.728,percent of total Billed Charges,62% of total Billed Charges,2057.16,2820.3,
32560 - TREAT PLEURODESIS W/AGENT TechFee,10105,CDM,450,RC,32560,HCPCS,Outpatient,,,1625,1137.5,,1300,80,,1040,percent of total Billed Charges,80% of Total Billed Charges,1023.75,63,,819,percent of total Billed charges,63% of Total Billed Charges,1007.5,62,,806,percent of total Billed Charges,62% of total BIlled charges,1023.75,63,,819,percent of total Billed Charges,63% of total Billed Charges,1381.25,85,,1105,percent of total Billed Charges,85% of total Billed Charges,1300,80,,1040,percent of total Billed Charges,80% of total Billed Charges,1007.5,62,,806,percent of total Billed Charges,62% of total Billed Charges,1023.75,63,,819,percent of total Billed Charges,63% of total Billed Charges,1007.5,62,,806,percent of total Billed Charges,62% of total Billed Charges,1023.75,63,,819,percent of total billed charges,63% of total Billed Charges,1007.5,62,,806,percent of total Billed Charges,62% of total Billed Charges,1300,80,,1040,percent of total Billed Charges,80% of Total Billed Charges,1007.5,62,,806,percent of total Billed Charges,62% of total Billed Charges,1007.5,62,,806,percent of total Billed Charges,62% of total Billed Charges,1007.5,1381.25,
36011 - CATH PLACE RNL/JUGLR TechFee,220138,CDM,450,RC,36011,HCPCS,Outpatient,,,495,346.5,,396,80,,316.8,percent of total Billed Charges,80% of Total Billed Charges,311.85,63,,249.48,percent of total Billed charges,63% of Total Billed Charges,306.9,62,,245.52,percent of total Billed Charges,62% of total BIlled charges,311.85,63,,249.48,percent of total Billed Charges,63% of total Billed Charges,420.75,85,,336.6,percent of total Billed Charges,85% of total Billed Charges,396,80,,316.8,percent of total Billed Charges,80% of total Billed Charges,306.9,62,,245.52,percent of total Billed Charges,62% of total Billed Charges,311.85,63,,249.48,percent of total Billed Charges,63% of total Billed Charges,306.9,62,,245.52,percent of total Billed Charges,62% of total Billed Charges,311.85,63,,249.48,percent of total billed charges,63% of total Billed Charges,306.9,62,,245.52,percent of total Billed Charges,62% of total Billed Charges,396,80,,316.8,percent of total Billed Charges,80% of Total Billed Charges,306.9,62,,245.52,percent of total Billed Charges,62% of total Billed Charges,306.9,62,,245.52,percent of total Billed Charges,62% of total Billed Charges,306.9,420.75,
36425 - ESTAB.ACCESS TO VEIN ED Tech Fee,220198,CDM,450,RC,36425,HCPCS,Outpatient,,,269,188.3,,215.2,80,,172.16,percent of total Billed Charges,80% of Total Billed Charges,169.47,63,,135.576,percent of total Billed charges,63% of Total Billed Charges,166.78,62,,133.424,percent of total Billed Charges,62% of total BIlled charges,169.47,63,,135.576,percent of total Billed Charges,63% of total Billed Charges,228.65,85,,182.92,percent of total Billed Charges,85% of total Billed Charges,215.2,80,,172.16,percent of total Billed Charges,80% of total Billed Charges,166.78,62,,133.424,percent of total Billed Charges,62% of total Billed Charges,169.47,63,,135.576,percent of total Billed Charges,63% of total Billed Charges,166.78,62,,133.424,percent of total Billed Charges,62% of total Billed Charges,169.47,63,,135.576,percent of total billed charges,63% of total Billed Charges,166.78,62,,133.424,percent of total Billed Charges,62% of total Billed Charges,215.2,80,,172.16,percent of total Billed Charges,80% of Total Billed Charges,166.78,62,,133.424,percent of total Billed Charges,62% of total Billed Charges,166.78,62,,133.424,percent of total Billed Charges,62% of total Billed Charges,166.78,228.65,
36555 - INSJ NON-TUNNELED CENTRAL VENOUS CATH AGE < 5 Y TechFee,220196,CDM,450,RC,36555,HCPCS,Outpatient,,,1721,1204.7,,1376.8,80,,1101.44,percent of total Billed Charges,80% of Total Billed Charges,1084.23,63,,867.384,percent of total Billed charges,63% of Total Billed Charges,1067.02,62,,853.616,percent of total Billed Charges,62% of total BIlled charges,1084.23,63,,867.384,percent of total Billed Charges,63% of total Billed Charges,1462.85,85,,1170.28,percent of total Billed Charges,85% of total Billed Charges,1376.8,80,,1101.44,percent of total Billed Charges,80% of total Billed Charges,1067.02,62,,853.616,percent of total Billed Charges,62% of total Billed Charges,1084.23,63,,867.384,percent of total Billed Charges,63% of total Billed Charges,1067.02,62,,853.616,percent of total Billed Charges,62% of total Billed Charges,1084.23,63,,867.384,percent of total billed charges,63% of total Billed Charges,1067.02,62,,853.616,percent of total Billed Charges,62% of total Billed Charges,1376.8,80,,1101.44,percent of total Billed Charges,80% of Total Billed Charges,1067.02,62,,853.616,percent of total Billed Charges,62% of total Billed Charges,1067.02,62,,853.616,percent of total Billed Charges,62% of total Billed Charges,1067.02,1462.85,
36556 - INSERT C VENOUS CATH ED Tech Fee,220197,CDM,450,RC,36556,HCPCS,Outpatient,,,1721,1204.7,,1376.8,80,,1101.44,percent of total Billed Charges,80% of Total Billed Charges,1084.23,63,,867.384,percent of total Billed charges,63% of Total Billed Charges,1067.02,62,,853.616,percent of total Billed Charges,62% of total BIlled charges,1084.23,63,,867.384,percent of total Billed Charges,63% of total Billed Charges,1462.85,85,,1170.28,percent of total Billed Charges,85% of total Billed Charges,1376.8,80,,1101.44,percent of total Billed Charges,80% of total Billed Charges,1067.02,62,,853.616,percent of total Billed Charges,62% of total Billed Charges,1084.23,63,,867.384,percent of total Billed Charges,63% of total Billed Charges,1067.02,62,,853.616,percent of total Billed Charges,62% of total Billed Charges,1084.23,63,,867.384,percent of total billed charges,63% of total Billed Charges,1067.02,62,,853.616,percent of total Billed Charges,62% of total Billed Charges,1376.8,80,,1101.44,percent of total Billed Charges,80% of Total Billed Charges,1067.02,62,,853.616,percent of total Billed Charges,62% of total Billed Charges,1067.02,62,,853.616,percent of total Billed Charges,62% of total Billed Charges,1067.02,1462.85,
36590 - RMVL TUN CTR VAD W/SUBQ PORT/PMP CTR/PRPH INSJ Tech Fee,220146,CDM,450,RC,36590,HCPCS,Outpatient,,,1734,1213.8,,1387.2,80,,1109.76,percent of total Billed Charges,80% of Total Billed Charges,1092.42,63,,873.936,percent of total Billed charges,63% of Total Billed Charges,1075.08,62,,860.064,percent of total Billed Charges,62% of total BIlled charges,1092.42,63,,873.936,percent of total Billed Charges,63% of total Billed Charges,1473.9,85,,1179.12,percent of total Billed Charges,85% of total Billed Charges,1387.2,80,,1109.76,percent of total Billed Charges,80% of total Billed Charges,1075.08,62,,860.064,percent of total Billed Charges,62% of total Billed Charges,1092.42,63,,873.936,percent of total Billed Charges,63% of total Billed Charges,1075.08,62,,860.064,percent of total Billed Charges,62% of total Billed Charges,1092.42,63,,873.936,percent of total billed charges,63% of total Billed Charges,1075.08,62,,860.064,percent of total Billed Charges,62% of total Billed Charges,1387.2,80,,1109.76,percent of total Billed Charges,80% of Total Billed Charges,1075.08,62,,860.064,percent of total Billed Charges,62% of total Billed Charges,1075.08,62,,860.064,percent of total Billed Charges,62% of total Billed Charges,1075.08,1473.9,
37785 - LIGATION VARICOSE VE TechFee,220139,CDM,450,RC,37785,HCPCS,Outpatient,,,4365,3055.5,,3492,80,,2793.6,percent of total Billed Charges,80% of Total Billed Charges,2749.95,63,,2199.96,percent of total Billed charges,63% of Total Billed Charges,2706.3,62,,2165.04,percent of total Billed Charges,62% of total BIlled charges,2749.95,63,,2199.96,percent of total Billed Charges,63% of total Billed Charges,3710.25,85,,2968.2,percent of total Billed Charges,85% of total Billed Charges,3492,80,,2793.6,percent of total Billed Charges,80% of total Billed Charges,2706.3,62,,2165.04,percent of total Billed Charges,62% of total Billed Charges,2749.95,63,,2199.96,percent of total Billed Charges,63% of total Billed Charges,2706.3,62,,2165.04,percent of total Billed Charges,62% of total Billed Charges,2749.95,63,,2199.96,percent of total billed charges,63% of total Billed Charges,2706.3,62,,2165.04,percent of total Billed Charges,62% of total Billed Charges,3492,80,,2793.6,percent of total Billed Charges,80% of Total Billed Charges,2706.3,62,,2165.04,percent of total Billed Charges,62% of total Billed Charges,2706.3,62,,2165.04,percent of total Billed Charges,62% of total Billed Charges,2706.3,3710.25,
38220 - ER- BONE MARROW ASPIRATION TechFee,585095,CDM,450,RC,38220,HCPCS,Outpatient,,,1308,915.6,,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,824.04,63,,659.232,percent of total Billed charges,63% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total BIlled charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,1111.8,85,,889.44,percent of total Billed Charges,85% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total Billed Charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,824.04,63,,659.232,percent of total billed charges,63% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,1046.4,80,,837.12,percent of total Billed Charges,80% of Total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,62,,648.768,percent of total Billed Charges,62% of total Billed Charges,810.96,1111.8,
40652 - REPAIR LIP FULL THICKNESS; UP TO HALF VERTICAL HEIGHT TechFee,540652,CDM,450,RC,40652,HCPCS,Outpatient,,,1326,928.2,,1060.8,80,,848.64,percent of total Billed Charges,80% of Total Billed Charges,835.38,63,,668.304,percent of total Billed charges,63% of Total Billed Charges,822.12,62,,657.696,percent of total Billed Charges,62% of total BIlled charges,835.38,63,,668.304,percent of total Billed Charges,63% of total Billed Charges,1127.1,85,,901.68,percent of total Billed Charges,85% of total Billed Charges,1060.8,80,,848.64,percent of total Billed Charges,80% of total Billed Charges,822.12,62,,657.696,percent of total Billed Charges,62% of total Billed Charges,835.38,63,,668.304,percent of total Billed Charges,63% of total Billed Charges,822.12,62,,657.696,percent of total Billed Charges,62% of total Billed Charges,835.38,63,,668.304,percent of total billed charges,63% of total Billed Charges,822.12,62,,657.696,percent of total Billed Charges,62% of total Billed Charges,1060.8,80,,848.64,percent of total Billed Charges,80% of Total Billed Charges,822.12,62,,657.696,percent of total Billed Charges,62% of total Billed Charges,822.12,62,,657.696,percent of total Billed Charges,62% of total Billed Charges,822.12,1127.1,
40654 - LAC VERMILLION2.6 > TechFee,540654,CDM,450,RC,40654,HCPCS,Outpatient,,,1326,928.2,,1060.8,80,,848.64,percent of total Billed Charges,80% of Total Billed Charges,835.38,63,,668.304,percent of total Billed charges,63% of Total Billed Charges,822.12,62,,657.696,percent of total Billed Charges,62% of total BIlled charges,835.38,63,,668.304,percent of total Billed Charges,63% of total Billed Charges,1127.1,85,,901.68,percent of total Billed Charges,85% of total Billed Charges,1060.8,80,,848.64,percent of total Billed Charges,80% of total Billed Charges,822.12,62,,657.696,percent of total Billed Charges,62% of total Billed Charges,835.38,63,,668.304,percent of total Billed Charges,63% of total Billed Charges,822.12,62,,657.696,percent of total Billed Charges,62% of total Billed Charges,835.38,63,,668.304,percent of total billed charges,63% of total Billed Charges,822.12,62,,657.696,percent of total Billed Charges,62% of total Billed Charges,1060.8,80,,848.64,percent of total Billed Charges,80% of Total Billed Charges,822.12,62,,657.696,percent of total Billed Charges,62% of total Billed Charges,822.12,62,,657.696,percent of total Billed Charges,62% of total Billed Charges,822.12,1127.1,
40899 - VESTIBULE OF MOUTH TechFee,220147,CDM,450,RC,40899,HCPCS,Outpatient,,,172,120.4,,137.6,80,,110.08,percent of total Billed Charges,80% of Total Billed Charges,108.36,63,,86.688,percent of total Billed charges,63% of Total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total BIlled charges,108.36,63,,86.688,percent of total Billed Charges,63% of total Billed Charges,146.2,85,,116.96,percent of total Billed Charges,85% of total Billed Charges,137.6,80,,110.08,percent of total Billed Charges,80% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,108.36,63,,86.688,percent of total Billed Charges,63% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,108.36,63,,86.688,percent of total billed charges,63% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,137.6,80,,110.08,percent of total Billed Charges,80% of Total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,106.64,62,,85.312,percent of total Billed Charges,62% of total Billed Charges,106.64,146.2,
41250 - TONGUE LACERATION < ED Tech Fee,541250,CDM,450,RC,41250,HCPCS,Outpatient,,,265,185.5,,212,80,,169.6,percent of total Billed Charges,80% of Total Billed Charges,166.95,63,,133.56,percent of total Billed charges,63% of Total Billed Charges,164.3,62,,131.44,percent of total Billed Charges,62% of total BIlled charges,166.95,63,,133.56,percent of total Billed Charges,63% of total Billed Charges,225.25,85,,180.2,percent of total Billed Charges,85% of total Billed Charges,212,80,,169.6,percent of total Billed Charges,80% of total Billed Charges,164.3,62,,131.44,percent of total Billed Charges,62% of total Billed Charges,166.95,63,,133.56,percent of total Billed Charges,63% of total Billed Charges,164.3,62,,131.44,percent of total Billed Charges,62% of total Billed Charges,166.95,63,,133.56,percent of total billed charges,63% of total Billed Charges,164.3,62,,131.44,percent of total Billed Charges,62% of total Billed Charges,212,80,,169.6,percent of total Billed Charges,80% of Total Billed Charges,164.3,62,,131.44,percent of total Billed Charges,62% of total Billed Charges,164.3,62,,131.44,percent of total Billed Charges,62% of total Billed Charges,164.3,225.25,
41252 - TONGUE LACERATION ED Tech Fee,541252,CDM,450,RC,41252,HCPCS,Outpatient,,,1113,779.1,,890.4,80,,712.32,percent of total Billed Charges,80% of Total Billed Charges,701.19,63,,560.952,percent of total Billed charges,63% of Total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total BIlled charges,701.19,63,,560.952,percent of total Billed Charges,63% of total Billed Charges,946.05,85,,756.84,percent of total Billed Charges,85% of total Billed Charges,890.4,80,,712.32,percent of total Billed Charges,80% of total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total Billed Charges,701.19,63,,560.952,percent of total Billed Charges,63% of total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total Billed Charges,701.19,63,,560.952,percent of total billed charges,63% of total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total Billed Charges,890.4,80,,712.32,percent of total Billed Charges,80% of Total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total Billed Charges,690.06,62,,552.048,percent of total Billed Charges,62% of total Billed Charges,690.06,946.05,
42809 - RMV FRGN BODY-PHARYN ED Tech Fee,220124,CDM,450,RC,42809,HCPCS,Outpatient,,,201,140.7,,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,126.63,63,,101.304,percent of total Billed charges,63% of Total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total BIlled charges,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,170.85,85,,136.68,percent of total Billed Charges,85% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,126.63,63,,101.304,percent of total billed charges,63% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,124.62,170.85,
43753 - GASTRIC INTUBATJ  ASPIRAJ W/PHYS SKILL/LAVAGE,220141,CDM,450,RC,43753,HCPCS,Outpatient,,,201,140.7,,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,126.63,63,,101.304,percent of total Billed charges,63% of Total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total BIlled charges,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,170.85,85,,136.68,percent of total Billed Charges,85% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,126.63,63,,101.304,percent of total billed charges,63% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,124.62,170.85,
44500 - GASTRO TUBE INSERT TechFee,220149,CDM,450,RC,44500,HCPCS,Outpatient,,,952,666.4,,761.6,80,,609.28,percent of total Billed Charges,80% of Total Billed Charges,599.76,63,,479.808,percent of total Billed charges,63% of Total Billed Charges,590.24,62,,472.192,percent of total Billed Charges,62% of total BIlled charges,599.76,63,,479.808,percent of total Billed Charges,63% of total Billed Charges,809.2,85,,647.36,percent of total Billed Charges,85% of total Billed Charges,761.6,80,,609.28,percent of total Billed Charges,80% of total Billed Charges,590.24,62,,472.192,percent of total Billed Charges,62% of total Billed Charges,599.76,63,,479.808,percent of total Billed Charges,63% of total Billed Charges,590.24,62,,472.192,percent of total Billed Charges,62% of total Billed Charges,599.76,63,,479.808,percent of total billed charges,63% of total Billed Charges,590.24,62,,472.192,percent of total Billed Charges,62% of total Billed Charges,761.6,80,,609.28,percent of total Billed Charges,80% of Total Billed Charges,590.24,62,,472.192,percent of total Billed Charges,62% of total Billed Charges,590.24,62,,472.192,percent of total Billed Charges,62% of total Billed Charges,590.24,809.2,
45915 - Removal of fecal impaction or foreign body (separate proc) under anesthesia TechFee,220150,CDM,450,RC,45915,HCPCS,Outpatient,,,2897,2027.9,,2317.6,80,,1854.08,percent of total Billed Charges,80% of Total Billed Charges,1825.11,63,,1460.088,percent of total Billed charges,63% of Total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total BIlled charges,1825.11,63,,1460.088,percent of total Billed Charges,63% of total Billed Charges,2462.45,85,,1969.96,percent of total Billed Charges,85% of total Billed Charges,2317.6,80,,1854.08,percent of total Billed Charges,80% of total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total Billed Charges,1825.11,63,,1460.088,percent of total Billed Charges,63% of total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total Billed Charges,1825.11,63,,1460.088,percent of total billed charges,63% of total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total Billed Charges,2317.6,80,,1854.08,percent of total Billed Charges,80% of Total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total Billed Charges,1796.14,2462.45,
46050 - INC. OF ANAL ABSCESS ED Tech Fee,220061,CDM,450,RC,46050,HCPCS,Outpatient,,,965,675.5,,772,80,,617.6,percent of total Billed Charges,80% of Total Billed Charges,607.95,63,,486.36,percent of total Billed charges,63% of Total Billed Charges,598.3,62,,478.64,percent of total Billed Charges,62% of total BIlled charges,607.95,63,,486.36,percent of total Billed Charges,63% of total Billed Charges,820.25,85,,656.2,percent of total Billed Charges,85% of total Billed Charges,772,80,,617.6,percent of total Billed Charges,80% of total Billed Charges,598.3,62,,478.64,percent of total Billed Charges,62% of total Billed Charges,607.95,63,,486.36,percent of total Billed Charges,63% of total Billed Charges,598.3,62,,478.64,percent of total Billed Charges,62% of total Billed Charges,607.95,63,,486.36,percent of total billed charges,63% of total Billed Charges,598.3,62,,478.64,percent of total Billed Charges,62% of total Billed Charges,772,80,,617.6,percent of total Billed Charges,80% of Total Billed Charges,598.3,62,,478.64,percent of total Billed Charges,62% of total Billed Charges,598.3,62,,478.64,percent of total Billed Charges,62% of total Billed Charges,598.3,820.25,
46083 - INCIS THROMB. HEMORR ED Tech Fee,220099,CDM,450,RC,46083,HCPCS,Outpatient,,,431,301.7,,344.8,80,,275.84,percent of total Billed Charges,80% of Total Billed Charges,271.53,63,,217.224,percent of total Billed charges,63% of Total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total BIlled charges,271.53,63,,217.224,percent of total Billed Charges,63% of total Billed Charges,366.35,85,,293.08,percent of total Billed Charges,85% of total Billed Charges,344.8,80,,275.84,percent of total Billed Charges,80% of total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,271.53,63,,217.224,percent of total Billed Charges,63% of total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,271.53,63,,217.224,percent of total billed charges,63% of total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,344.8,80,,275.84,percent of total Billed Charges,80% of Total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,267.22,366.35,
46320 - EXC THROMBOSED HEMORRHOID XTRNL TechFee,546320,CDM,450,RC,46320,HCPCS,Outpatient,,,2897,2027.9,,2317.6,80,,1854.08,percent of total Billed Charges,80% of Total Billed Charges,1825.11,63,,1460.088,percent of total Billed charges,63% of Total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total BIlled charges,1825.11,63,,1460.088,percent of total Billed Charges,63% of total Billed Charges,2462.45,85,,1969.96,percent of total Billed Charges,85% of total Billed Charges,2317.6,80,,1854.08,percent of total Billed Charges,80% of total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total Billed Charges,1825.11,63,,1460.088,percent of total Billed Charges,63% of total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total Billed Charges,1825.11,63,,1460.088,percent of total billed charges,63% of total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total Billed Charges,2317.6,80,,1854.08,percent of total Billed Charges,80% of Total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total Billed Charges,1796.14,62,,1436.912,percent of total Billed Charges,62% of total Billed Charges,1796.14,2462.45,
49082 - Incision Procedures on the Abdomen Peritoneum and Omentum TechFee,10104,CDM,450,RC,49082,HCPCS,Outpatient,,,2358,1650.6,,1886.4,80,,1509.12,percent of total Billed Charges,80% of Total Billed Charges,1485.54,63,,1188.432,percent of total Billed charges,63% of Total Billed Charges,1461.96,62,,1169.568,percent of total Billed Charges,62% of total BIlled charges,1485.54,63,,1188.432,percent of total Billed Charges,63% of total Billed Charges,2004.3,85,,1603.44,percent of total Billed Charges,85% of total Billed Charges,1886.4,80,,1509.12,percent of total Billed Charges,80% of total Billed Charges,1461.96,62,,1169.568,percent of total Billed Charges,62% of total Billed Charges,1485.54,63,,1188.432,percent of total Billed Charges,63% of total Billed Charges,1461.96,62,,1169.568,percent of total Billed Charges,62% of total Billed Charges,1485.54,63,,1188.432,percent of total billed charges,63% of total Billed Charges,1461.96,62,,1169.568,percent of total Billed Charges,62% of total Billed Charges,1886.4,80,,1509.12,percent of total Billed Charges,80% of Total Billed Charges,1461.96,62,,1169.568,percent of total Billed Charges,62% of total Billed Charges,1461.96,62,,1169.568,percent of total Billed Charges,62% of total Billed Charges,1461.96,2004.3,
51703 - ER - FOLEY CATHETER COMPLICATED (BALLOON) TechFee,220064,CDM,450,RC,51703,HCPCS,Outpatient,,,431,301.7,,344.8,80,,275.84,percent of total Billed Charges,80% of Total Billed Charges,271.53,63,,217.224,percent of total Billed charges,63% of Total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total BIlled charges,271.53,63,,217.224,percent of total Billed Charges,63% of total Billed Charges,366.35,85,,293.08,percent of total Billed Charges,85% of total Billed Charges,344.8,80,,275.84,percent of total Billed Charges,80% of total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,271.53,63,,217.224,percent of total Billed Charges,63% of total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,271.53,63,,217.224,percent of total billed charges,63% of total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,344.8,80,,275.84,percent of total Billed Charges,80% of Total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,267.22,366.35,
56405 - INC. DRAIN ABSCESS ED Tech Fee,220065,CDM,450,RC,56405,HCPCS,Outpatient,,,387,270.9,,309.6,80,,247.68,percent of total Billed Charges,80% of Total Billed Charges,243.81,63,,195.048,percent of total Billed charges,63% of Total Billed Charges,239.94,62,,191.952,percent of total Billed Charges,62% of total BIlled charges,243.81,63,,195.048,percent of total Billed Charges,63% of total Billed Charges,328.95,85,,263.16,percent of total Billed Charges,85% of total Billed Charges,309.6,80,,247.68,percent of total Billed Charges,80% of total Billed Charges,239.94,62,,191.952,percent of total Billed Charges,62% of total Billed Charges,243.81,63,,195.048,percent of total Billed Charges,63% of total Billed Charges,239.94,62,,191.952,percent of total Billed Charges,62% of total Billed Charges,243.81,63,,195.048,percent of total billed charges,63% of total Billed Charges,239.94,62,,191.952,percent of total Billed Charges,62% of total Billed Charges,309.6,80,,247.68,percent of total Billed Charges,80% of Total Billed Charges,239.94,62,,191.952,percent of total Billed Charges,62% of total Billed Charges,239.94,62,,191.952,percent of total Billed Charges,62% of total Billed Charges,239.94,328.95,
56420 - DRAINAGE OF GLAND AB ED Tech Fee,220092,CDM,450,RC,56420,HCPCS,Outpatient,,,259,181.3,,207.2,80,,165.76,percent of total Billed Charges,80% of Total Billed Charges,163.17,63,,130.536,percent of total Billed charges,63% of Total Billed Charges,160.58,62,,128.464,percent of total Billed Charges,62% of total BIlled charges,163.17,63,,130.536,percent of total Billed Charges,63% of total Billed Charges,220.15,85,,176.12,percent of total Billed Charges,85% of total Billed Charges,207.2,80,,165.76,percent of total Billed Charges,80% of total Billed Charges,160.58,62,,128.464,percent of total Billed Charges,62% of total Billed Charges,163.17,63,,130.536,percent of total Billed Charges,63% of total Billed Charges,160.58,62,,128.464,percent of total Billed Charges,62% of total Billed Charges,163.17,63,,130.536,percent of total billed charges,63% of total Billed Charges,160.58,62,,128.464,percent of total Billed Charges,62% of total Billed Charges,207.2,80,,165.76,percent of total Billed Charges,80% of Total Billed Charges,160.58,62,,128.464,percent of total Billed Charges,62% of total Billed Charges,160.58,62,,128.464,percent of total Billed Charges,62% of total Billed Charges,160.58,220.15,
57415 - RMV FB VAGINA TechFee,220126,CDM,450,RC,57415,HCPCS,Outpatient,,,2806,1964.2,,2244.8,80,,1795.84,percent of total Billed Charges,80% of Total Billed Charges,1767.78,63,,1414.224,percent of total Billed charges,63% of Total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total BIlled charges,1767.78,63,,1414.224,percent of total Billed Charges,63% of total Billed Charges,2385.1,85,,1908.08,percent of total Billed Charges,85% of total Billed Charges,2244.8,80,,1795.84,percent of total Billed Charges,80% of total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,1767.78,63,,1414.224,percent of total Billed Charges,63% of total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,1767.78,63,,1414.224,percent of total billed charges,63% of total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,2244.8,80,,1795.84,percent of total Billed Charges,80% of Total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,1739.72,2385.1,
59409 - VAGINAL DELIVERY ONLY TechFee,220093,CDM,450,RC,59409,HCPCS,Outpatient,,,2806,1964.2,,2244.8,80,,1795.84,percent of total Billed Charges,80% of Total Billed Charges,1767.78,63,,1414.224,percent of total Billed charges,63% of Total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total BIlled charges,1767.78,63,,1414.224,percent of total Billed Charges,63% of total Billed Charges,2385.1,85,,1908.08,percent of total Billed Charges,85% of total Billed Charges,2244.8,80,,1795.84,percent of total Billed Charges,80% of total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,1767.78,63,,1414.224,percent of total Billed Charges,63% of total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,1767.78,63,,1414.224,percent of total billed charges,63% of total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,2244.8,80,,1795.84,percent of total Billed Charges,80% of Total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,1739.72,2385.1,
59414 - DELIVERY PLACENTA SEPARATE PROCEDURE TechFee,220094,CDM,450,RC,59414,HCPCS,Outpatient,,,2806,1964.2,,2244.8,80,,1795.84,percent of total Billed Charges,80% of Total Billed Charges,1767.78,63,,1414.224,percent of total Billed charges,63% of Total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total BIlled charges,1767.78,63,,1414.224,percent of total Billed Charges,63% of total Billed Charges,2385.1,85,,1908.08,percent of total Billed Charges,85% of total Billed Charges,2244.8,80,,1795.84,percent of total Billed Charges,80% of total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,1767.78,63,,1414.224,percent of total Billed Charges,63% of total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,1767.78,63,,1414.224,percent of total billed charges,63% of total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,2244.8,80,,1795.84,percent of total Billed Charges,80% of Total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,1739.72,62,,1391.776,percent of total Billed Charges,62% of total Billed Charges,1739.72,2385.1,
62270 - Lumbar Puncture Diagnost TechFee,220095,CDM,450,RC,62270,HCPCS,Outpatient,,,722,505.4,,577.6,80,,462.08,percent of total Billed Charges,80% of Total Billed Charges,454.86,63,,363.888,percent of total Billed charges,63% of Total Billed Charges,447.64,62,,358.112,percent of total Billed Charges,62% of total BIlled charges,454.86,63,,363.888,percent of total Billed Charges,63% of total Billed Charges,613.7,85,,490.96,percent of total Billed Charges,85% of total Billed Charges,577.6,80,,462.08,percent of total Billed Charges,80% of total Billed Charges,447.64,62,,358.112,percent of total Billed Charges,62% of total Billed Charges,454.86,63,,363.888,percent of total Billed Charges,63% of total Billed Charges,447.64,62,,358.112,percent of total Billed Charges,62% of total Billed Charges,454.86,63,,363.888,percent of total billed charges,63% of total Billed Charges,447.64,62,,358.112,percent of total Billed Charges,62% of total Billed Charges,577.6,80,,462.08,percent of total Billed Charges,80% of Total Billed Charges,447.64,62,,358.112,percent of total Billed Charges,62% of total Billed Charges,447.64,62,,358.112,percent of total Billed Charges,62% of total Billed Charges,447.64,613.7,
62282 - EPIDURAL LUMBAR SACR TechFee,562282,CDM,450,RC,62282,HCPCS,Outpatient,,,3153,2207.1,,2522.4,80,,2017.92,percent of total Billed Charges,80% of Total Billed Charges,1986.39,63,,1589.112,percent of total Billed charges,63% of Total Billed Charges,1954.86,62,,1563.888,percent of total Billed Charges,62% of total BIlled charges,1986.39,63,,1589.112,percent of total Billed Charges,63% of total Billed Charges,2680.05,85,,2144.04,percent of total Billed Charges,85% of total Billed Charges,2522.4,80,,2017.92,percent of total Billed Charges,80% of total Billed Charges,1954.86,62,,1563.888,percent of total Billed Charges,62% of total Billed Charges,1986.39,63,,1589.112,percent of total Billed Charges,63% of total Billed Charges,1954.86,62,,1563.888,percent of total Billed Charges,62% of total Billed Charges,1986.39,63,,1589.112,percent of total billed charges,63% of total Billed Charges,1954.86,62,,1563.888,percent of total Billed Charges,62% of total Billed Charges,2522.4,80,,2017.92,percent of total Billed Charges,80% of Total Billed Charges,1954.86,62,,1563.888,percent of total Billed Charges,62% of total Billed Charges,1954.86,62,,1563.888,percent of total Billed Charges,62% of total Billed Charges,1954.86,2680.05,
64450 - Digital Nerve Block Tech Fee,220096,CDM,450,RC,64450,HCPCS,Outpatient,,,722,505.4,,577.6,80,,462.08,percent of total Billed Charges,80% of Total Billed Charges,454.86,63,,363.888,percent of total Billed charges,63% of Total Billed Charges,447.64,62,,358.112,percent of total Billed Charges,62% of total BIlled charges,454.86,63,,363.888,percent of total Billed Charges,63% of total Billed Charges,613.7,85,,490.96,percent of total Billed Charges,85% of total Billed Charges,577.6,80,,462.08,percent of total Billed Charges,80% of total Billed Charges,447.64,62,,358.112,percent of total Billed Charges,62% of total Billed Charges,454.86,63,,363.888,percent of total Billed Charges,63% of total Billed Charges,447.64,62,,358.112,percent of total Billed Charges,62% of total Billed Charges,454.86,63,,363.888,percent of total billed charges,63% of total Billed Charges,447.64,62,,358.112,percent of total Billed Charges,62% of total Billed Charges,577.6,80,,462.08,percent of total Billed Charges,80% of Total Billed Charges,447.64,62,,358.112,percent of total Billed Charges,62% of total Billed Charges,447.64,62,,358.112,percent of total Billed Charges,62% of total Billed Charges,447.64,613.7,
65210 - REMOVAL OF EXTERNAL BODY EXTERNAL EYE,220082,CDM,450,RC,65210,HCPCS,Outpatient,,,158,110.6,,126.4,80,,101.12,percent of total Billed Charges,80% of Total Billed Charges,99.54,63,,79.632,percent of total Billed charges,63% of Total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total BIlled charges,99.54,63,,79.632,percent of total Billed Charges,63% of total Billed Charges,134.3,85,,107.44,percent of total Billed Charges,85% of total Billed Charges,126.4,80,,101.12,percent of total Billed Charges,80% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,99.54,63,,79.632,percent of total Billed Charges,63% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,99.54,63,,79.632,percent of total billed charges,63% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,126.4,80,,101.12,percent of total Billed Charges,80% of Total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,97.96,134.3,
65220 - REMOVE FB CORNEAL W/O TechFee,220083,CDM,450,RC,65220,HCPCS,Outpatient,,,158,110.6,,126.4,80,,101.12,percent of total Billed Charges,80% of Total Billed Charges,99.54,63,,79.632,percent of total Billed charges,63% of Total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total BIlled charges,99.54,63,,79.632,percent of total Billed Charges,63% of total Billed Charges,134.3,85,,107.44,percent of total Billed Charges,85% of total Billed Charges,126.4,80,,101.12,percent of total Billed Charges,80% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,99.54,63,,79.632,percent of total Billed Charges,63% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,99.54,63,,79.632,percent of total billed charges,63% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,126.4,80,,101.12,percent of total Billed Charges,80% of Total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,97.96,134.3,
65222 - ER- REMOVAL FOREIGN BODY CORNEAL W SLIT LAMP TechFee,220084,CDM,450,RC,65222,HCPCS,Outpatient,,,158,110.6,,126.4,80,,101.12,percent of total Billed Charges,80% of Total Billed Charges,99.54,63,,79.632,percent of total Billed charges,63% of Total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total BIlled charges,99.54,63,,79.632,percent of total Billed Charges,63% of total Billed Charges,134.3,85,,107.44,percent of total Billed Charges,85% of total Billed Charges,126.4,80,,101.12,percent of total Billed Charges,80% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,99.54,63,,79.632,percent of total Billed Charges,63% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,99.54,63,,79.632,percent of total billed charges,63% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,126.4,80,,101.12,percent of total Billed Charges,80% of Total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,97.96,134.3,
69000 - DRAIN EXTERN.EAR LES ED Tech Fee,220207,CDM,450,RC,69000,HCPCS,Outpatient,,,330,231,,264,80,,211.2,percent of total Billed Charges,80% of Total Billed Charges,207.9,63,,166.32,percent of total Billed charges,63% of Total Billed Charges,204.6,62,,163.68,percent of total Billed Charges,62% of total BIlled charges,207.9,63,,166.32,percent of total Billed Charges,63% of total Billed Charges,280.5,85,,224.4,percent of total Billed Charges,85% of total Billed Charges,264,80,,211.2,percent of total Billed Charges,80% of total Billed Charges,204.6,62,,163.68,percent of total Billed Charges,62% of total Billed Charges,207.9,63,,166.32,percent of total Billed Charges,63% of total Billed Charges,204.6,62,,163.68,percent of total Billed Charges,62% of total Billed Charges,207.9,63,,166.32,percent of total billed charges,63% of total Billed Charges,204.6,62,,163.68,percent of total Billed Charges,62% of total Billed Charges,264,80,,211.2,percent of total Billed Charges,80% of Total Billed Charges,204.6,62,,163.68,percent of total Billed Charges,62% of total Billed Charges,204.6,62,,163.68,percent of total Billed Charges,62% of total Billed Charges,204.6,280.5,
69200 - REMOVE FB EAR CANAL W/O A TechFee,569200,CDM,450,RC,69200,HCPCS,Outpatient,,,109,76.3,,87.2,80,,69.76,percent of total Billed Charges,80% of Total Billed Charges,68.67,63,,54.936,percent of total Billed charges,63% of Total Billed Charges,67.58,62,,54.064,percent of total Billed Charges,62% of total BIlled charges,68.67,63,,54.936,percent of total Billed Charges,63% of total Billed Charges,92.65,85,,74.12,percent of total Billed Charges,85% of total Billed Charges,87.2,80,,69.76,percent of total Billed Charges,80% of total Billed Charges,67.58,62,,54.064,percent of total Billed Charges,62% of total Billed Charges,68.67,63,,54.936,percent of total Billed Charges,63% of total Billed Charges,67.58,62,,54.064,percent of total Billed Charges,62% of total Billed Charges,68.67,63,,54.936,percent of total billed charges,63% of total Billed Charges,67.58,62,,54.064,percent of total Billed Charges,62% of total Billed Charges,87.2,80,,69.76,percent of total Billed Charges,80% of Total Billed Charges,67.58,62,,54.064,percent of total Billed Charges,62% of total Billed Charges,67.58,62,,54.064,percent of total Billed Charges,62% of total Billed Charges,67.58,92.65,
6920950 REMOVAL CERUMEN W/IRRIGAT TechFee,220104,CDM,450,RC,69209,HCPCS,Outpatient,,,112,78.4,,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,70.56,63,,56.448,percent of total Billed charges,63% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total BIlled charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,95.2,85,,76.16,percent of total Billed Charges,85% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total billed charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,95.2,
92950 - CPR TechFee,220157,CDM,450,RC,92950,HCPCS,Outpatient,,,326,228.2,,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,205.38,63,,164.304,percent of total Billed charges,63% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total BIlled charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,277.1,85,,221.68,percent of total Billed Charges,85% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total billed charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,277.1,
99151 - Mod Sedation Same Phys Initial 15 Min LT 5 years TechFee,220220,CDM,450,RC,99151,HCPCS,Outpatient,,,337,235.9,,269.6,80,,215.68,percent of total Billed Charges,80% of Total Billed Charges,212.31,63,,169.848,percent of total Billed charges,63% of Total Billed Charges,208.94,62,,167.152,percent of total Billed Charges,62% of total BIlled charges,212.31,63,,169.848,percent of total Billed Charges,63% of total Billed Charges,286.45,85,,229.16,percent of total Billed Charges,85% of total Billed Charges,269.6,80,,215.68,percent of total Billed Charges,80% of total Billed Charges,208.94,62,,167.152,percent of total Billed Charges,62% of total Billed Charges,212.31,63,,169.848,percent of total Billed Charges,63% of total Billed Charges,208.94,62,,167.152,percent of total Billed Charges,62% of total Billed Charges,212.31,63,,169.848,percent of total billed charges,63% of total Billed Charges,208.94,62,,167.152,percent of total Billed Charges,62% of total Billed Charges,269.6,80,,215.68,percent of total Billed Charges,80% of Total Billed Charges,208.94,62,,167.152,percent of total Billed Charges,62% of total Billed Charges,208.94,62,,167.152,percent of total Billed Charges,62% of total Billed Charges,208.94,286.45,
99152 - Mod Sedation Same Phys Initial 15 Min GTE 5 years TechFee,220221,CDM,450,RC,99152,HCPCS,Outpatient,,,342,239.4,,273.6,80,,218.88,percent of total Billed Charges,80% of Total Billed Charges,215.46,63,,172.368,percent of total Billed charges,63% of Total Billed Charges,212.04,62,,169.632,percent of total Billed Charges,62% of total BIlled charges,215.46,63,,172.368,percent of total Billed Charges,63% of total Billed Charges,290.7,85,,232.56,percent of total Billed Charges,85% of total Billed Charges,273.6,80,,218.88,percent of total Billed Charges,80% of total Billed Charges,212.04,62,,169.632,percent of total Billed Charges,62% of total Billed Charges,215.46,63,,172.368,percent of total Billed Charges,63% of total Billed Charges,212.04,62,,169.632,percent of total Billed Charges,62% of total Billed Charges,215.46,63,,172.368,percent of total billed charges,63% of total Billed Charges,212.04,62,,169.632,percent of total Billed Charges,62% of total Billed Charges,273.6,80,,218.88,percent of total Billed Charges,80% of Total Billed Charges,212.04,62,,169.632,percent of total Billed Charges,62% of total Billed Charges,212.04,62,,169.632,percent of total Billed Charges,62% of total Billed Charges,212.04,290.7,
99153 - Mod Sedation Same Phys Ea Addl 15 Min TechFee,220222,CDM,450,RC,99153,HCPCS,Outpatient,,,138,96.6,,110.4,80,,88.32,percent of total Billed Charges,80% of Total Billed Charges,86.94,63,,69.552,percent of total Billed charges,63% of Total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total BIlled charges,86.94,63,,69.552,percent of total Billed Charges,63% of total Billed Charges,117.3,85,,93.84,percent of total Billed Charges,85% of total Billed Charges,110.4,80,,88.32,percent of total Billed Charges,80% of total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total Billed Charges,86.94,63,,69.552,percent of total Billed Charges,63% of total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total Billed Charges,86.94,63,,69.552,percent of total billed charges,63% of total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total Billed Charges,110.4,80,,88.32,percent of total Billed Charges,80% of Total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total Billed Charges,85.56,62,,68.448,percent of total Billed Charges,62% of total Billed Charges,85.56,117.3,
92960 - ED Cardioversion,220086,CDM,450,RC,92960,HCPCS,Outpatient,,,901,630.7,,720.8,80,,576.64,percent of total Billed Charges,80% of Total Billed Charges,567.63,63,,454.104,percent of total Billed charges,63% of Total Billed Charges,558.62,62,,446.896,percent of total Billed Charges,62% of total BIlled charges,567.63,63,,454.104,percent of total Billed Charges,63% of total Billed Charges,765.85,85,,612.68,percent of total Billed Charges,85% of total Billed Charges,720.8,80,,576.64,percent of total Billed Charges,80% of total Billed Charges,558.62,62,,446.896,percent of total Billed Charges,62% of total Billed Charges,567.63,63,,454.104,percent of total Billed Charges,63% of total Billed Charges,558.62,62,,446.896,percent of total Billed Charges,62% of total Billed Charges,567.63,63,,454.104,percent of total billed charges,63% of total Billed Charges,558.62,62,,446.896,percent of total Billed Charges,62% of total Billed Charges,720.8,80,,576.64,percent of total Billed Charges,80% of Total Billed Charges,558.62,62,,446.896,percent of total Billed Charges,62% of total Billed Charges,558.62,62,,446.896,percent of total Billed Charges,62% of total Billed Charges,558.62,765.85,
96367- IV tx. sequential infusion,220190,CDM,450,RC,96367,HCPCS,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,56.7,63,,45.36,percent of total Billed charges,63% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total BIlled charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total billed charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,76.5,
36592 - Blood drawn,220159,CDM,450,RC,36592,HCPCS,Outpatient,,,165,115.5,,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,103.95,63,,83.16,percent of total Billed charges,63% of Total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total BIlled charges,103.95,63,,83.16,percent of total Billed Charges,63% of total Billed Charges,140.25,85,,112.2,percent of total Billed Charges,85% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,103.95,63,,83.16,percent of total Billed Charges,63% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,103.95,63,,83.16,percent of total billed charges,63% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,102.3,140.25,
51798 - Bladder Distention - Absent,10100,CDM,450,RC,51798,HCPCS,Outpatient,,,112,78.4,,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,70.56,63,,56.448,percent of total Billed charges,63% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total BIlled charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,95.2,85,,76.16,percent of total Billed Charges,85% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total billed charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,95.2,
51703 - Urinary Catheter Type: Coude,220318,CDM,450,RC,51703,HCPCS,Outpatient,,,431,301.7,,344.8,80,,275.84,percent of total Billed Charges,80% of Total Billed Charges,271.53,63,,217.224,percent of total Billed charges,63% of Total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total BIlled charges,271.53,63,,217.224,percent of total Billed Charges,63% of total Billed Charges,366.35,85,,293.08,percent of total Billed Charges,85% of total Billed Charges,344.8,80,,275.84,percent of total Billed Charges,80% of total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,271.53,63,,217.224,percent of total Billed Charges,63% of total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,271.53,63,,217.224,percent of total billed charges,63% of total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,344.8,80,,275.84,percent of total Billed Charges,80% of Total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,267.22,366.35,
"69209 - Ear, Bilateral",10099,CDM,450,RC,69209,HCPCS,Outpatient,,,224,156.8,,179.2,80,,143.36,percent of total Billed Charges,80% of Total Billed Charges,141.12,63,,112.896,percent of total Billed charges,63% of Total Billed Charges,138.88,62,,111.104,percent of total Billed Charges,62% of total BIlled charges,141.12,63,,112.896,percent of total Billed Charges,63% of total Billed Charges,190.4,85,,152.32,percent of total Billed Charges,85% of total Billed Charges,179.2,80,,143.36,percent of total Billed Charges,80% of total Billed Charges,138.88,62,,111.104,percent of total Billed Charges,62% of total Billed Charges,141.12,63,,112.896,percent of total Billed Charges,63% of total Billed Charges,138.88,62,,111.104,percent of total Billed Charges,62% of total Billed Charges,141.12,63,,112.896,percent of total billed charges,63% of total Billed Charges,138.88,62,,111.104,percent of total Billed Charges,62% of total Billed Charges,179.2,80,,143.36,percent of total Billed Charges,80% of Total Billed Charges,138.88,62,,111.104,percent of total Billed Charges,62% of total Billed Charges,138.88,62,,111.104,percent of total Billed Charges,62% of total Billed Charges,138.88,190.4,
69209 - Ear Irrigation - Left,10098,CDM,450,RC,69209,HCPCS,Outpatient,,,112,78.4,,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,70.56,63,,56.448,percent of total Billed charges,63% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total BIlled charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,95.2,85,,76.16,percent of total Billed Charges,85% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total billed charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,95.2,
69209 - Ear Irrigation - Right,10099,CDM,450,RC,69209,HCPCS,Outpatient,,,112,78.4,,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,70.56,63,,56.448,percent of total Billed charges,63% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total BIlled charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,95.2,85,,76.16,percent of total Billed Charges,85% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total billed charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,95.2,
51798 - Bladder Distention - Present,10100,CDM,450,RC,51798,HCPCS,Outpatient,,,112,78.4,,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,70.56,63,,56.448,percent of total Billed charges,63% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total BIlled charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,95.2,85,,76.16,percent of total Billed Charges,85% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total billed charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,95.2,
92953 - External Pacing,220085,CDM,450,RC,92953,HCPCS,Outpatient,,,326,228.2,,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,205.38,63,,164.304,percent of total Billed charges,63% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total BIlled charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,277.1,85,,221.68,percent of total Billed Charges,85% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total billed charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,277.1,
51700 - Urinary Catheter Irrigant In,220063,CDM,450,RC,51700,HCPCS,Outpatient,,,431,301.7,,344.8,80,,275.84,percent of total Billed Charges,80% of Total Billed Charges,271.53,63,,217.224,percent of total Billed charges,63% of Total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total BIlled charges,271.53,63,,217.224,percent of total Billed Charges,63% of total Billed Charges,366.35,85,,293.08,percent of total Billed Charges,85% of total Billed Charges,344.8,80,,275.84,percent of total Billed Charges,80% of total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,271.53,63,,217.224,percent of total Billed Charges,63% of total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,271.53,63,,217.224,percent of total billed charges,63% of total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,344.8,80,,275.84,percent of total Billed Charges,80% of Total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,267.22,366.35,
92953 - External Pacing,220085,CDM,450,RC,92953,HCPCS,Outpatient,,,326,228.2,,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,205.38,63,,164.304,percent of total Billed charges,63% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total BIlled charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,277.1,85,,221.68,percent of total Billed Charges,85% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total billed charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,277.1,
"93017 CARDIOVASCULAR STRESS TEST, PERFORMED CHARGE",93017,CDM,460,RC,93017,HCPCS,Outpatient,,,561,392.7,59,448.8,80,,359.04,percent of total Billed Charges,80% of Total Billed Charges,353.43,63,,282.744,percent of total Billed charges,63% of Total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total BIlled charges,353.43,63,,282.744,percent of total Billed Charges,63% of total Billed Charges,476.85,85,,381.48,percent of total Billed Charges,85% of total Billed Charges,448.8,80,,359.04,percent of total Billed Charges,80% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,353.43,63,,282.744,percent of total Billed Charges,63% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,353.43,63,,282.744,percent of total billed charges,63% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,448.8,80,,359.04,percent of total Billed Charges,80% of Total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,347.82,62,,278.256,percent of total Billed Charges,62% of total Billed Charges,347.82,476.85,
94625 Pulmonary Rehab W/O Oximetry Monitoring WLMH,94625,CDM,460,RC,94625,HCPCS,Outpatient,,,115,80.5,59,92,80,,73.6,percent of total Billed Charges,80% of Total Billed Charges,72.45,63,,57.96,percent of total Billed charges,63% of Total Billed Charges,71.3,62,,57.04,percent of total Billed Charges,62% of total BIlled charges,72.45,63,,57.96,percent of total Billed Charges,63% of total Billed Charges,97.75,85,,78.2,percent of total Billed Charges,85% of total Billed Charges,92,80,,73.6,percent of total Billed Charges,80% of total Billed Charges,71.3,62,,57.04,percent of total Billed Charges,62% of total Billed Charges,72.45,63,,57.96,percent of total Billed Charges,63% of total Billed Charges,71.3,62,,57.04,percent of total Billed Charges,62% of total Billed Charges,72.45,63,,57.96,percent of total billed charges,63% of total Billed Charges,71.3,62,,57.04,percent of total Billed Charges,62% of total Billed Charges,92,80,,73.6,percent of total Billed Charges,80% of Total Billed Charges,71.3,62,,57.04,percent of total Billed Charges,62% of total Billed Charges,71.3,62,,57.04,percent of total Billed Charges,62% of total Billed Charges,71.3,97.75,
94060 - Bronch resp spiro/pre/post dilator,441001,CDM,460,RC,94060,HCPCS,Outpatient,,,498,348.6,59,398.4,80,,318.72,percent of total Billed Charges,80% of Total Billed Charges,313.74,63,,250.992,percent of total Billed charges,63% of Total Billed Charges,308.76,62,,247.008,percent of total Billed Charges,62% of total BIlled charges,313.74,63,,250.992,percent of total Billed Charges,63% of total Billed Charges,423.3,85,,338.64,percent of total Billed Charges,85% of total Billed Charges,398.4,80,,318.72,percent of total Billed Charges,80% of total Billed Charges,308.76,62,,247.008,percent of total Billed Charges,62% of total Billed Charges,313.74,63,,250.992,percent of total Billed Charges,63% of total Billed Charges,308.76,62,,247.008,percent of total Billed Charges,62% of total Billed Charges,313.74,63,,250.992,percent of total billed charges,63% of total Billed Charges,308.76,62,,247.008,percent of total Billed Charges,62% of total Billed Charges,398.4,80,,318.72,percent of total Billed Charges,80% of Total Billed Charges,308.76,62,,247.008,percent of total Billed Charges,62% of total Billed Charges,308.76,62,,247.008,percent of total Billed Charges,62% of total Billed Charges,308.76,423.3,
94617 - Exercise test for bronchospasm including pre- and post-spir 94617,441005,CDM,460,RC,94617,HCPCS,Outpatient,,,210,147,59,168,80,,134.4,percent of total Billed Charges,80% of Total Billed Charges,132.3,63,,105.84,percent of total Billed charges,63% of Total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total BIlled charges,132.3,63,,105.84,percent of total Billed Charges,63% of total Billed Charges,178.5,85,,142.8,percent of total Billed Charges,85% of total Billed Charges,168,80,,134.4,percent of total Billed Charges,80% of total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,132.3,63,,105.84,percent of total Billed Charges,63% of total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,132.3,63,,105.84,percent of total billed charges,63% of total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,168,80,,134.4,percent of total Billed Charges,80% of Total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,130.2,178.5,
94727 - Gas dilu/washout/det lung volumes,441022,CDM,460,RC,94727,HCPCS,Outpatient,,,408,285.6,59,326.4,80,,261.12,percent of total Billed Charges,80% of Total Billed Charges,257.04,63,,205.632,percent of total Billed charges,63% of Total Billed Charges,252.96,62,,202.368,percent of total Billed Charges,62% of total BIlled charges,257.04,63,,205.632,percent of total Billed Charges,63% of total Billed Charges,346.8,85,,277.44,percent of total Billed Charges,85% of total Billed Charges,326.4,80,,261.12,percent of total Billed Charges,80% of total Billed Charges,252.96,62,,202.368,percent of total Billed Charges,62% of total Billed Charges,257.04,63,,205.632,percent of total Billed Charges,63% of total Billed Charges,252.96,62,,202.368,percent of total Billed Charges,62% of total Billed Charges,257.04,63,,205.632,percent of total billed charges,63% of total Billed Charges,252.96,62,,202.368,percent of total Billed Charges,62% of total Billed Charges,326.4,80,,261.12,percent of total Billed Charges,80% of Total Billed Charges,252.96,62,,202.368,percent of total Billed Charges,62% of total Billed Charges,252.96,62,,202.368,percent of total Billed Charges,62% of total Billed Charges,252.96,346.8,
94200 - Max breathing cap/max volunt vent,441003,CDM,460,RC,94200,HCPCS,Outpatient,,,210,147,59,168,80,,134.4,percent of total Billed Charges,80% of Total Billed Charges,132.3,63,,105.84,percent of total Billed charges,63% of Total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total BIlled charges,132.3,63,,105.84,percent of total Billed Charges,63% of total Billed Charges,178.5,85,,142.8,percent of total Billed Charges,85% of total Billed Charges,168,80,,134.4,percent of total Billed Charges,80% of total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,132.3,63,,105.84,percent of total Billed Charges,63% of total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,132.3,63,,105.84,percent of total billed charges,63% of total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,168,80,,134.4,percent of total Billed Charges,80% of Total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,130.2,178.5,
G0239 - Oth resp proc group G0239,441019,CDM,460,RC,,,Outpatient,,,64,44.8,59,51.2,80,,40.96,percent of total Billed Charges,80% of Total Billed Charges,40.32,63,,32.256,percent of total Billed charges,63% of Total Billed Charges,39.68,62,,31.744,percent of total Billed Charges,62% of total BIlled charges,40.32,63,,32.256,percent of total Billed Charges,63% of total Billed Charges,54.4,85,,43.52,percent of total Billed Charges,85% of total Billed Charges,51.2,80,,40.96,percent of total Billed Charges,80% of total Billed Charges,39.68,62,,31.744,percent of total Billed Charges,62% of total Billed Charges,40.32,63,,32.256,percent of total Billed Charges,63% of total Billed Charges,39.68,62,,31.744,percent of total Billed Charges,62% of total Billed Charges,40.32,63,,32.256,percent of total billed charges,63% of total Billed Charges,39.68,62,,31.744,percent of total Billed Charges,62% of total Billed Charges,51.2,80,,40.96,percent of total Billed Charges,80% of Total Billed Charges,39.68,62,,31.744,percent of total Billed Charges,62% of total Billed Charges,39.68,62,,31.744,percent of total Billed Charges,62% of total Billed Charges,39.68,54.4,
"Oth resp proc, individual G0238",441018,CDM,460,RC,,,Outpatient,,,64,44.8,59,51.2,80,,40.96,percent of total Billed Charges,80% of Total Billed Charges,40.32,63,,32.256,percent of total Billed charges,63% of Total Billed Charges,39.68,62,,31.744,percent of total Billed Charges,62% of total BIlled charges,40.32,63,,32.256,percent of total Billed Charges,63% of total Billed Charges,54.4,85,,43.52,percent of total Billed Charges,85% of total Billed Charges,51.2,80,,40.96,percent of total Billed Charges,80% of total Billed Charges,39.68,62,,31.744,percent of total Billed Charges,62% of total Billed Charges,40.32,63,,32.256,percent of total Billed Charges,63% of total Billed Charges,39.68,62,,31.744,percent of total Billed Charges,62% of total Billed Charges,40.32,63,,32.256,percent of total billed charges,63% of total Billed Charges,39.68,62,,31.744,percent of total Billed Charges,62% of total Billed Charges,51.2,80,,40.96,percent of total Billed Charges,80% of Total Billed Charges,39.68,62,,31.744,percent of total Billed Charges,62% of total Billed Charges,39.68,62,,31.744,percent of total Billed Charges,62% of total Billed Charges,39.68,54.4,
94640 - Inhalation tx/AAO/therapeutic/diag,441008,CDM,460,RC,94640,HCPCS,Outpatient,,,373,261.1,59,298.4,80,,238.72,percent of total Billed Charges,80% of Total Billed Charges,234.99,63,,187.992,percent of total Billed charges,63% of Total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total BIlled charges,234.99,63,,187.992,percent of total Billed Charges,63% of total Billed Charges,317.05,85,,253.64,percent of total Billed Charges,85% of total Billed Charges,298.4,80,,238.72,percent of total Billed Charges,80% of total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total Billed Charges,234.99,63,,187.992,percent of total Billed Charges,63% of total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total Billed Charges,234.99,63,,187.992,percent of total billed charges,63% of total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total Billed Charges,298.4,80,,238.72,percent of total Billed Charges,80% of Total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total Billed Charges,231.26,62,,185.008,percent of total Billed Charges,62% of total Billed Charges,231.26,317.05,
Pulmonary Rehab W/ Oximetry Monitoring 94626,441020,CDM,460,RC,94626,HCPCS,Outpatient,,,112,78.4,59,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,70.56,63,,56.448,percent of total Billed charges,63% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total BIlled charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,95.2,85,,76.16,percent of total Billed Charges,85% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total billed charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,95.2,
94618 - Pulmonary stress testing (eg 6-minute walk test) 94618,441006,CDM,460,RC,94618,HCPCS,Outpatient,,,210,147,59,168,80,,134.4,percent of total Billed Charges,80% of Total Billed Charges,132.3,63,,105.84,percent of total Billed charges,63% of Total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total BIlled charges,132.3,63,,105.84,percent of total Billed Charges,63% of total Billed Charges,178.5,85,,142.8,percent of total Billed Charges,85% of total Billed Charges,168,80,,134.4,percent of total Billed Charges,80% of total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,132.3,63,,105.84,percent of total Billed Charges,63% of total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,132.3,63,,105.84,percent of total billed charges,63% of total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,168,80,,134.4,percent of total Billed Charges,80% of Total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,130.2,62,,104.16,percent of total Billed Charges,62% of total Billed Charges,130.2,178.5,
94375 - Respiratory Flow Volume Loop,441021,CDM,460,RC,94375,HCPCS,Outpatient,,,746,522.2,59,596.8,80,,477.44,percent of total Billed Charges,80% of Total Billed Charges,469.98,63,,375.984,percent of total Billed charges,63% of Total Billed Charges,462.52,62,,370.016,percent of total Billed Charges,62% of total BIlled charges,469.98,63,,375.984,percent of total Billed Charges,63% of total Billed Charges,634.1,85,,507.28,percent of total Billed Charges,85% of total Billed Charges,596.8,80,,477.44,percent of total Billed Charges,80% of total Billed Charges,462.52,62,,370.016,percent of total Billed Charges,62% of total Billed Charges,469.98,63,,375.984,percent of total Billed Charges,63% of total Billed Charges,462.52,62,,370.016,percent of total Billed Charges,62% of total Billed Charges,469.98,63,,375.984,percent of total billed charges,63% of total Billed Charges,462.52,62,,370.016,percent of total Billed Charges,62% of total Billed Charges,596.8,80,,477.44,percent of total Billed Charges,80% of Total Billed Charges,462.52,62,,370.016,percent of total Billed Charges,62% of total Billed Charges,462.52,62,,370.016,percent of total Billed Charges,62% of total Billed Charges,462.52,634.1,
94010 - Spirometry/graph/vit cap/exp flow,441000,CDM,460,RC,94010,HCPCS,Outpatient,,,273,191.1,59,218.4,80,,174.72,percent of total Billed Charges,80% of Total Billed Charges,171.99,63,,137.592,percent of total Billed charges,63% of Total Billed Charges,169.26,62,,135.408,percent of total Billed Charges,62% of total BIlled charges,171.99,63,,137.592,percent of total Billed Charges,63% of total Billed Charges,232.05,85,,185.64,percent of total Billed Charges,85% of total Billed Charges,218.4,80,,174.72,percent of total Billed Charges,80% of total Billed Charges,169.26,62,,135.408,percent of total Billed Charges,62% of total Billed Charges,171.99,63,,137.592,percent of total Billed Charges,63% of total Billed Charges,169.26,62,,135.408,percent of total Billed Charges,62% of total Billed Charges,171.99,63,,137.592,percent of total billed charges,63% of total Billed Charges,169.26,62,,135.408,percent of total Billed Charges,62% of total Billed Charges,218.4,80,,174.72,percent of total Billed Charges,80% of Total Billed Charges,169.26,62,,135.408,percent of total Billed Charges,62% of total Billed Charges,169.26,62,,135.408,percent of total Billed Charges,62% of total Billed Charges,169.26,232.05,
Therapeutic procd strg endur G0237,441017,CDM,460,RC,,,Outpatient,,,64,44.8,59,51.2,80,,40.96,percent of total Billed Charges,80% of Total Billed Charges,40.32,63,,32.256,percent of total Billed charges,63% of Total Billed Charges,39.68,62,,31.744,percent of total Billed Charges,62% of total BIlled charges,40.32,63,,32.256,percent of total Billed Charges,63% of total Billed Charges,54.4,85,,43.52,percent of total Billed Charges,85% of total Billed Charges,51.2,80,,40.96,percent of total Billed Charges,80% of total Billed Charges,39.68,62,,31.744,percent of total Billed Charges,62% of total Billed Charges,40.32,63,,32.256,percent of total Billed Charges,63% of total Billed Charges,39.68,62,,31.744,percent of total Billed Charges,62% of total Billed Charges,40.32,63,,32.256,percent of total billed charges,63% of total Billed Charges,39.68,62,,31.744,percent of total Billed Charges,62% of total Billed Charges,51.2,80,,40.96,percent of total Billed Charges,80% of Total Billed Charges,39.68,62,,31.744,percent of total Billed Charges,62% of total Billed Charges,39.68,62,,31.744,percent of total Billed Charges,62% of total Billed Charges,39.68,54.4,
94799 - Unlisted pulmonary serv/proc,441014,CDM,460,RC,94799,HCPCS,Outpatient,,,409,286.3,59,327.2,80,,261.76,percent of total Billed Charges,80% of Total Billed Charges,257.67,63,,206.136,percent of total Billed charges,63% of Total Billed Charges,253.58,62,,202.864,percent of total Billed Charges,62% of total BIlled charges,257.67,63,,206.136,percent of total Billed Charges,63% of total Billed Charges,347.65,85,,278.12,percent of total Billed Charges,85% of total Billed Charges,327.2,80,,261.76,percent of total Billed Charges,80% of total Billed Charges,253.58,62,,202.864,percent of total Billed Charges,62% of total Billed Charges,257.67,63,,206.136,percent of total Billed Charges,63% of total Billed Charges,253.58,62,,202.864,percent of total Billed Charges,62% of total Billed Charges,257.67,63,,206.136,percent of total billed charges,63% of total Billed Charges,253.58,62,,202.864,percent of total Billed Charges,62% of total Billed Charges,327.2,80,,261.76,percent of total Billed Charges,80% of Total Billed Charges,253.58,62,,202.864,percent of total Billed Charges,62% of total Billed Charges,253.58,62,,202.864,percent of total Billed Charges,62% of total Billed Charges,253.58,347.65,
94150 - Vital capacity total,441002,CDM,460,RC,94150,HCPCS,Outpatient,,,409,286.3,59,327.2,80,,261.76,percent of total Billed Charges,80% of Total Billed Charges,257.67,63,,206.136,percent of total Billed charges,63% of Total Billed Charges,253.58,62,,202.864,percent of total Billed Charges,62% of total BIlled charges,257.67,63,,206.136,percent of total Billed Charges,63% of total Billed Charges,347.65,85,,278.12,percent of total Billed Charges,85% of total Billed Charges,327.2,80,,261.76,percent of total Billed Charges,80% of total Billed Charges,253.58,62,,202.864,percent of total Billed Charges,62% of total Billed Charges,257.67,63,,206.136,percent of total Billed Charges,63% of total Billed Charges,253.58,62,,202.864,percent of total Billed Charges,62% of total Billed Charges,257.67,63,,206.136,percent of total billed charges,63% of total Billed Charges,253.58,62,,202.864,percent of total Billed Charges,62% of total Billed Charges,327.2,80,,261.76,percent of total Billed Charges,80% of Total Billed Charges,253.58,62,,202.864,percent of total Billed Charges,62% of total Billed Charges,253.58,62,,202.864,percent of total Billed Charges,62% of total Billed Charges,253.58,347.65,
94625 Pulmonary Rehab W/O Oximetry Monitoring,94625,CDM,460,RC,94625,HCPCS,Outpatient,,,115,80.5,59,92,80,,73.6,percent of total Billed Charges,80% of Total Billed Charges,72.45,63,,57.96,percent of total Billed charges,63% of Total Billed Charges,71.3,62,,57.04,percent of total Billed Charges,62% of total BIlled charges,72.45,63,,57.96,percent of total Billed Charges,63% of total Billed Charges,97.75,85,,78.2,percent of total Billed Charges,85% of total Billed Charges,92,80,,73.6,percent of total Billed Charges,80% of total Billed Charges,71.3,62,,57.04,percent of total Billed Charges,62% of total Billed Charges,72.45,63,,57.96,percent of total Billed Charges,63% of total Billed Charges,71.3,62,,57.04,percent of total Billed Charges,62% of total Billed Charges,72.45,63,,57.96,percent of total billed charges,63% of total Billed Charges,71.3,62,,57.04,percent of total Billed Charges,62% of total Billed Charges,92,80,,73.6,percent of total Billed Charges,80% of Total Billed Charges,71.3,62,,57.04,percent of total Billed Charges,62% of total Billed Charges,71.3,62,,57.04,percent of total Billed Charges,62% of total Billed Charges,71.3,97.75,
94762 - RT Overnight Oximetry CHARGE,150132,CDM,460,RC,94762,HCPCS,Outpatient,,,268,187.6,59,214.4,80,,171.52,percent of total Billed Charges,80% of Total Billed Charges,168.84,63,,135.072,percent of total Billed charges,63% of Total Billed Charges,166.16,62,,132.928,percent of total Billed Charges,62% of total BIlled charges,168.84,63,,135.072,percent of total Billed Charges,63% of total Billed Charges,227.8,85,,182.24,percent of total Billed Charges,85% of total Billed Charges,214.4,80,,171.52,percent of total Billed Charges,80% of total Billed Charges,166.16,62,,132.928,percent of total Billed Charges,62% of total Billed Charges,168.84,63,,135.072,percent of total Billed Charges,63% of total Billed Charges,166.16,62,,132.928,percent of total Billed Charges,62% of total Billed Charges,168.84,63,,135.072,percent of total billed charges,63% of total Billed Charges,166.16,62,,132.928,percent of total Billed Charges,62% of total Billed Charges,214.4,80,,171.52,percent of total Billed Charges,80% of Total Billed Charges,166.16,62,,132.928,percent of total Billed Charges,62% of total Billed Charges,166.16,62,,132.928,percent of total Billed Charges,62% of total Billed Charges,166.16,227.8,
93308 - US Echo Doppler Limited,180125,CDM,480,RC,93308,HCPCS,Outpatient,,,502,351.4,,401.6,80,,321.28,percent of total Billed Charges,80% of Total Billed Charges,316.26,63,,253.008,percent of total Billed charges,63% of Total Billed Charges,311.24,62,,248.992,percent of total Billed Charges,62% of total BIlled charges,316.26,63,,253.008,percent of total Billed Charges,63% of total Billed Charges,426.7,85,,341.36,percent of total Billed Charges,85% of total Billed Charges,401.6,80,,321.28,percent of total Billed Charges,80% of total Billed Charges,311.24,62,,248.992,percent of total Billed Charges,62% of total Billed Charges,316.26,63,,253.008,percent of total Billed Charges,63% of total Billed Charges,311.24,62,,248.992,percent of total Billed Charges,62% of total Billed Charges,316.26,63,,253.008,percent of total billed charges,63% of total Billed Charges,311.24,62,,248.992,percent of total Billed Charges,62% of total Billed Charges,401.6,80,,321.28,percent of total Billed Charges,80% of Total Billed Charges,311.24,62,,248.992,percent of total Billed Charges,62% of total Billed Charges,311.24,62,,248.992,percent of total Billed Charges,62% of total Billed Charges,311.24,426.7,
36591 - ER - COLLECTION BLOOD THRU CATHETER TechFee,220158,CDM,500,RC,36591,HCPCS,Outpatient,,,165,115.5,,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,103.95,63,,83.16,percent of total Billed charges,63% of Total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total BIlled charges,103.95,63,,83.16,percent of total Billed Charges,63% of total Billed Charges,140.25,85,,112.2,percent of total Billed Charges,85% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,103.95,63,,83.16,percent of total Billed Charges,63% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,103.95,63,,83.16,percent of total billed charges,63% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,102.3,140.25,
51701 - CATH INSERT-Straight-ER TechFee,553670,CDM,500,RC,51701,HCPCS,Outpatient,,,201,140.7,,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,126.63,63,,101.304,percent of total Billed charges,63% of Total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total BIlled charges,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,170.85,85,,136.68,percent of total Billed Charges,85% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,126.63,63,,101.304,percent of total billed charges,63% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,124.62,170.85,
51702 - CATH INSERT FOLEY-ER TechFee,220160,CDM,500,RC,51702,HCPCS,Outpatient,,,201,140.7,,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,126.63,63,,101.304,percent of total Billed charges,63% of Total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total BIlled charges,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,170.85,85,,136.68,percent of total Billed Charges,85% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,126.63,63,,101.304,percent of total billed charges,63% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,124.62,170.85,
65205 - REMOVAL FB EYE CONJUNCTIVAL SUPERFICIAL TechFee,220081,CDM,500,RC,65205,HCPCS,Outpatient,,,158,110.6,,126.4,80,,101.12,percent of total Billed Charges,80% of Total Billed Charges,99.54,63,,79.632,percent of total Billed charges,63% of Total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total BIlled charges,99.54,63,,79.632,percent of total Billed Charges,63% of total Billed Charges,134.3,85,,107.44,percent of total Billed Charges,85% of total Billed Charges,126.4,80,,101.12,percent of total Billed Charges,80% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,99.54,63,,79.632,percent of total Billed Charges,63% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,99.54,63,,79.632,percent of total billed charges,63% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,126.4,80,,101.12,percent of total Billed Charges,80% of Total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,97.96,134.3,
99211 - OFC OR OTHER O/P VISIT TechFee,220132,CDM,510,RC,99211,HCPCS,Outpatient,,,68,47.6,,54.4,80,,43.52,percent of total Billed Charges,80% of Total Billed Charges,42.84,63,,34.272,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,42.84,63,,34.272,percent of total Billed Charges,63% of total Billed Charges,57.8,85,,46.24,percent of total Billed Charges,85% of total Billed Charges,54.4,80,,43.52,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,42.84,63,,34.272,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,42.84,63,,34.272,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,54.4,80,,43.52,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,42.84,190.02,
96372 INJECTION SUBQ OR IM,220235,CDM,510,RC,96372,HCPCS,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,56.7,63,,45.36,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,56.7,63,,45.36,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,56.7,190.02,
99211 TREATMENT ROOM CHARGE,220132,CDM,510,RC,99211,HCPCS,Outpatient,,,68,47.6,,54.4,80,,43.52,percent of total Billed Charges,80% of Total Billed Charges,42.84,63,,34.272,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,42.84,63,,34.272,percent of total Billed Charges,63% of total Billed Charges,57.8,85,,46.24,percent of total Billed Charges,85% of total Billed Charges,54.4,80,,43.52,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,42.84,63,,34.272,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,42.84,63,,34.272,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,54.4,80,,43.52,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,42.84,190.02,
96372 Inj Subq/IM,83350,CDM,510,RC,96372,HCPCS,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,56.7,63,,45.36,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,56.7,63,,45.36,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,56.7,190.02,
51700 - Urinary Catheter - Indwelling/Continuous,10053,CDM,510,RC,51702,HCPCS,Outpatient,,,201,140.7,,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,126.63,63,,101.304,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,170.85,85,,136.68,percent of total Billed Charges,85% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,126.63,63,,101.304,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,126.63,190.02,
Clinic visit,220318,CDM,510,RC,51703,HCPCS,Outpatient,,,280,196,,224,80,,179.2,percent of total Billed Charges,80% of Total Billed Charges,176.4,63,,141.12,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,176.4,63,,141.12,percent of total Billed Charges,63% of total Billed Charges,238,85,,190.4,percent of total Billed Charges,85% of total Billed Charges,224,80,,179.2,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,176.4,63,,141.12,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,176.4,63,,141.12,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,224,80,,179.2,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,176.4,238,
51701 Straight/Intermittent,51701,CDM,510,RC,51701,HCPCS,Outpatient,,,201,140.7,,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,126.63,63,,101.304,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,170.85,85,,136.68,percent of total Billed Charges,85% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,126.63,63,,101.304,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,126.63,190.02,
36592 - Blood drawn,220159,CDM,510,RC,36592,HCPCS,Outpatient,,,165,115.5,,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,103.95,63,,83.16,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,103.95,63,,83.16,percent of total Billed Charges,63% of total Billed Charges,140.25,85,,112.2,percent of total Billed Charges,85% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,103.95,63,,83.16,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,103.95,63,,83.16,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,103.95,190.02,
"69209 - Ear, Bilateral",10099,CDM,510,RC,69209,HCPCS,Outpatient,,,218,152.6,,174.4,80,,139.52,percent of total Billed Charges,80% of Total Billed Charges,137.34,63,,109.872,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,137.34,63,,109.872,percent of total Billed Charges,63% of total Billed Charges,185.3,85,,148.24,percent of total Billed Charges,85% of total Billed Charges,174.4,80,,139.52,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,137.34,63,,109.872,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,137.34,63,,109.872,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,174.4,80,,139.52,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,137.34,190.02,
69209 - Ear Irrigation - Left,10098,CDM,510,RC,69209,HCPCS,Outpatient,,,109,76.3,,87.2,80,,69.76,percent of total Billed Charges,80% of Total Billed Charges,68.67,63,,54.936,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,68.67,63,,54.936,percent of total Billed Charges,63% of total Billed Charges,92.65,85,,74.12,percent of total Billed Charges,85% of total Billed Charges,87.2,80,,69.76,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,68.67,63,,54.936,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,68.67,63,,54.936,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,87.2,80,,69.76,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,68.67,190.02,
69209 - Ear Irrigation - Right,10099,CDM,510,RC,69209,HCPCS,Outpatient,,,109,76.3,,87.2,80,,69.76,percent of total Billed Charges,80% of Total Billed Charges,68.67,63,,54.936,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,68.67,63,,54.936,percent of total Billed Charges,63% of total Billed Charges,92.65,85,,74.12,percent of total Billed Charges,85% of total Billed Charges,87.2,80,,69.76,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,68.67,63,,54.936,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,68.67,63,,54.936,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,87.2,80,,69.76,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,68.67,190.02,
Clinic Visits,84223,CDM,521,RC,87430,HCPCS,Outpatient,,,25,17.5,QW,20,80,,16,percent of total Billed Charges,80% of Total Billed Charges,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,204.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.25,85,,17,percent of total Billed Charges,85% of total Billed Charges,20,80,,16,percent of total Billed Charges,80% of total Billed Charges,207,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,204.95,100,,,Case Rate,Pays Based on per visit Rate,15.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,204.95,100,,,Case Rate,Pays Based on per visit Rate,20,80,,16,percent of total Billed Charges,80% of Total Billed Charges,204.95,100,,,Case Rate,Pays Based on per visit Rate,204.95,100,,,Case Rate,Pays Based on per visit Rate,15.08,207,
Immunological Fecal Occult Blood POCT,84190,CDM,521,RC,82274,HCPCS,Outpatient,,,24,16.8,QW,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,21.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,204.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.4,85,,16.32,percent of total Billed Charges,85% of total Billed Charges,19.2,80,,15.36,percent of total Billed Charges,80% of total Billed Charges,206.1,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,21.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,204.06,100,,,Case Rate,Pays Based on per visit Rate,22.12,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,204.06,100,,,Case Rate,Pays Based on per visit Rate,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,204.06,100,,,Case Rate,Pays Based on per visit Rate,204.06,100,,,Case Rate,Pays Based on per visit Rate,19.2,206.1,
Clinic Visits,84190,CDM,521,RC,82274,HCPCS,Outpatient,,,24,16.8,QW,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,21.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,204.06,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,21.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,20.4,85,,16.32,percent of total Billed Charges,85% of total Billed Charges,19.2,80,,15.36,percent of total Billed Charges,80% of total Billed Charges,206.1,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,21.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,204.06,100,,,Case Rate,Pays Based on per visit Rate,22.12,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,204.06,100,,,Case Rate,Pays Based on per visit Rate,19.2,80,,15.36,percent of total Billed Charges,80% of Total Billed Charges,204.06,100,,,Case Rate,Pays Based on per visit Rate,204.06,100,,,Case Rate,Pays Based on per visit Rate,19.2,206.1,
Clinic Visits,84222,CDM,521,RC,87420,HCPCS,Outpatient,,,21,14.7,QW,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,202.05,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,17.85,85,,14.28,percent of total Billed Charges,85% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of total Billed Charges,204.07,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,202.05,100,,,Case Rate,Pays Based on per visit Rate,15.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,202.05,100,,,Case Rate,Pays Based on per visit Rate,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,202.05,100,,,Case Rate,Pays Based on per visit Rate,202.05,100,,,Case Rate,Pays Based on per visit Rate,15.08,204.07,
Clinic Visits,84220,CDM,521,RC,87428,HCPCS,Outpatient,,,95,66.5,QW,76,80,,60.8,percent of total Billed Charges,80% of Total Billed Charges,67.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,258.43,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,67.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,80.75,85,,64.6,percent of total Billed Charges,85% of total Billed Charges,76,80,,60.8,percent of total Billed Charges,80% of total Billed Charges,261.01,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,67.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,258.43,100,,,Case Rate,Pays Based on per visit Rate,68.42,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,258.43,100,,,Case Rate,Pays Based on per visit Rate,76,80,,60.8,percent of total Billed Charges,80% of Total Billed Charges,258.43,100,,,Case Rate,Pays Based on per visit Rate,258.43,100,,,Case Rate,Pays Based on per visit Rate,67.08,261.01,
Clinic Visits,84223,CDM,521,RC,87430,HCPCS,Outpatient,,,25,17.5,QW,20,80,,16,percent of total Billed Charges,80% of Total Billed Charges,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,204.95,100,,,Fee Schedule,Pays based on 100% of CMS OPPS Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,21.25,85,,17,percent of total Billed Charges,85% of total Billed Charges,20,80,,16,percent of total Billed Charges,80% of total Billed Charges,207,101,,,Fee Schedule,101% of CMS OPPS Fee Schedule Rate,15.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,204.95,100,,,Case Rate,Pays Based on per visit Rate,15.38,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,204.95,100,,,Case Rate,Pays Based on per visit Rate,20,80,,16,percent of total Billed Charges,80% of Total Billed Charges,204.95,100,,,Case Rate,Pays Based on per visit Rate,204.95,100,,,Case Rate,Pays Based on per visit Rate,15.08,207,
96372 No Charge,83350,CDM,521,RC,96372,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,188.14,100,,,Case Rate,Pays based on per visit Rate ,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,190.02,100,,,case rate,pays based on per visit rate,,,,,Other,Not Separately reimbursable,188.14,100,,,Case Rate,Pays Based on per visit Rate,,,,,Other,Not Separately reimbursable,188.14,100,,,Case Rate,Pays Based on per visit Rate,,,,,Other,Not Separately reimbursable,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,190.02,
99221 INITIAL HOSP INPT OR OBS CARE STRTFWD/LOW 40 MIN ProFee,99221,CDM,521,RC,99221,HCPCS,Outpatient,,,144,100.8,,115.2,80,,92.16,percent of total Billed Charges,80% of Total Billed Charges,90.72,63,,72.576,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,90.72,63,,72.576,percent of total Billed Charges,63% of total Billed Charges,122.4,85,,97.92,percent of total Billed Charges,85% of total Billed Charges,115.2,80,,92.16,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,90.72,63,,72.576,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,90.72,63,,72.576,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,115.2,80,,92.16,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,90.72,190.02,
99221 INITIAL HOSP INPT OR OBS CARE STRTFWD/LOW 40 MIN ProFee,99221,CDM,521,RC,99221,HCPCS,Outpatient,,,144,100.8,,115.2,80,,92.16,percent of total Billed Charges,80% of Total Billed Charges,90.72,63,,72.576,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,90.72,63,,72.576,percent of total Billed Charges,63% of total Billed Charges,122.4,85,,97.92,percent of total Billed Charges,85% of total Billed Charges,115.2,80,,92.16,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,90.72,63,,72.576,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,90.72,63,,72.576,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,115.2,80,,92.16,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,90.72,190.02,
99222 INITIAL HOSP INPT OR OBS CARE MODERATE 55 MIN ProFee,99222,CDM,521,RC,99222,HCPCS,Outpatient,,,194,135.8,,155.2,80,,124.16,percent of total Billed Charges,80% of Total Billed Charges,122.22,63,,97.776,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,122.22,63,,97.776,percent of total Billed Charges,63% of total Billed Charges,164.9,85,,131.92,percent of total Billed Charges,85% of total Billed Charges,155.2,80,,124.16,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,122.22,63,,97.776,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,122.22,63,,97.776,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,155.2,80,,124.16,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,122.22,190.02,
99222 INITIAL HOSP INPT OR OBS CARE MODERATE 55 MIN ProFee,99222,CDM,521,RC,99222,HCPCS,Outpatient,,,194,135.8,,155.2,80,,124.16,percent of total Billed Charges,80% of Total Billed Charges,122.22,63,,97.776,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,122.22,63,,97.776,percent of total Billed Charges,63% of total Billed Charges,164.9,85,,131.92,percent of total Billed Charges,85% of total Billed Charges,155.2,80,,124.16,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,122.22,63,,97.776,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,122.22,63,,97.776,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,155.2,80,,124.16,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,122.22,190.02,
99223 INITIAL HOSP INPT OR OBS CARE HIGH 75 MIN ProFee,99223,CDM,521,RC,99223,HCPCS,Outpatient,,,287,200.9,,229.6,80,,183.68,percent of total Billed Charges,80% of Total Billed Charges,180.81,63,,144.648,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,180.81,63,,144.648,percent of total Billed Charges,63% of total Billed Charges,243.95,85,,195.16,percent of total Billed Charges,85% of total Billed Charges,229.6,80,,183.68,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,180.81,63,,144.648,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,180.81,63,,144.648,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,229.6,80,,183.68,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,180.81,243.95,
99223 INITIAL HOSP INPT OR OBS CARE HIGH 75 MIN ProFee,99223,CDM,521,RC,99223,HCPCS,Outpatient,,,287,200.9,,229.6,80,,183.68,percent of total Billed Charges,80% of Total Billed Charges,180.81,63,,144.648,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,180.81,63,,144.648,percent of total Billed Charges,63% of total Billed Charges,243.95,85,,195.16,percent of total Billed Charges,85% of total Billed Charges,229.6,80,,183.68,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,180.81,63,,144.648,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,180.81,63,,144.648,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,229.6,80,,183.68,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,180.81,243.95,
99231 SUBSQ HOSP INPT OR OBS CARE STRTFWD/LOW 25 MIN ProFee,99231,CDM,521,RC,99231,HCPCS,Outpatient,,,56,39.2,,44.8,80,,35.84,percent of total Billed Charges,80% of Total Billed Charges,35.28,63,,28.224,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,35.28,63,,28.224,percent of total Billed Charges,63% of total Billed Charges,47.6,85,,38.08,percent of total Billed Charges,85% of total Billed Charges,44.8,80,,35.84,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,35.28,63,,28.224,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,35.28,63,,28.224,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,44.8,80,,35.84,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,35.28,190.02,
99231 SUBSQ HOSP INPT OR OBS CARE STRTFWD/LOW 25 MIN ProFee,99231,CDM,521,RC,99231,HCPCS,Outpatient,,,56,39.2,,44.8,80,,35.84,percent of total Billed Charges,80% of Total Billed Charges,35.28,63,,28.224,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,35.28,63,,28.224,percent of total Billed Charges,63% of total Billed Charges,47.6,85,,38.08,percent of total Billed Charges,85% of total Billed Charges,44.8,80,,35.84,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,35.28,63,,28.224,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,35.28,63,,28.224,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,44.8,80,,35.84,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,35.28,190.02,
99232 SUBSQ HOSP INPT OR OBS CARE MODERATE 35 MIN ProFee,99232,CDM,521,RC,99232,HCPCS,Outpatient,,,103,72.1,,82.4,80,,65.92,percent of total Billed Charges,80% of Total Billed Charges,64.89,63,,51.912,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,64.89,63,,51.912,percent of total Billed Charges,63% of total Billed Charges,87.55,85,,70.04,percent of total Billed Charges,85% of total Billed Charges,82.4,80,,65.92,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,64.89,63,,51.912,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,64.89,63,,51.912,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,82.4,80,,65.92,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,64.89,190.02,
99232 SUBSQ HOSP INPT OR OBS CARE MODERATE 35 MIN ProFee,99232,CDM,521,RC,99232,HCPCS,Outpatient,,,103,72.1,,82.4,80,,65.92,percent of total Billed Charges,80% of Total Billed Charges,64.89,63,,51.912,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,64.89,63,,51.912,percent of total Billed Charges,63% of total Billed Charges,87.55,85,,70.04,percent of total Billed Charges,85% of total Billed Charges,82.4,80,,65.92,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,64.89,63,,51.912,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,64.89,63,,51.912,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,82.4,80,,65.92,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,64.89,190.02,
99233 SUBSQ HOSP INPT OR OBS CARE HIGH 50 MIN ProFee,99233,CDM,521,RC,99233,HCPCS,Outpatient,,,148,103.6,,118.4,80,,94.72,percent of total Billed Charges,80% of Total Billed Charges,93.24,63,,74.592,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,93.24,63,,74.592,percent of total Billed Charges,63% of total Billed Charges,125.8,85,,100.64,percent of total Billed Charges,85% of total Billed Charges,118.4,80,,94.72,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,93.24,63,,74.592,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,93.24,63,,74.592,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,118.4,80,,94.72,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,93.24,190.02,
99233 SUBSQ HOSP INPT OR OBS CARE HIGH 50 MIN ProFee,99233,CDM,521,RC,99233,HCPCS,Outpatient,,,148,103.6,,118.4,80,,94.72,percent of total Billed Charges,80% of Total Billed Charges,93.24,63,,74.592,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,93.24,63,,74.592,percent of total Billed Charges,63% of total Billed Charges,125.8,85,,100.64,percent of total Billed Charges,85% of total Billed Charges,118.4,80,,94.72,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,93.24,63,,74.592,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,93.24,63,,74.592,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,118.4,80,,94.72,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,93.24,190.02,
99234 HOSP INPT OR OBS CARE ADMIT/DC SAME DAY STRTFWD/LOW 45 MIN ProFee,99234,CDM,521,RC,99234,HCPCS,Outpatient,,,181,126.7,,144.8,80,,115.84,percent of total Billed Charges,80% of Total Billed Charges,114.03,63,,91.224,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,114.03,63,,91.224,percent of total Billed Charges,63% of total Billed Charges,153.85,85,,123.08,percent of total Billed Charges,85% of total Billed Charges,144.8,80,,115.84,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,114.03,63,,91.224,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,114.03,63,,91.224,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,144.8,80,,115.84,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,114.03,190.02,
99234 HOSP INPT OR OBS CARE ADMIT/DC SAME DAY STRTFWD/LOW 45 MIN ProFee,99234,CDM,521,RC,99234,HCPCS,Outpatient,,,181,126.7,,144.8,80,,115.84,percent of total Billed Charges,80% of Total Billed Charges,114.03,63,,91.224,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,114.03,63,,91.224,percent of total Billed Charges,63% of total Billed Charges,153.85,85,,123.08,percent of total Billed Charges,85% of total Billed Charges,144.8,80,,115.84,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,114.03,63,,91.224,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,114.03,63,,91.224,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,144.8,80,,115.84,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,114.03,190.02,
99235 HOSP INPT OR OBS CARE ADMIT/DC SAME DAY MODERATE 70 MIN ProFee,99235,CDM,521,RC,99235,HCPCS,Outpatient,,,240,168,,192,80,,153.6,percent of total Billed Charges,80% of Total Billed Charges,151.2,63,,120.96,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,151.2,63,,120.96,percent of total Billed Charges,63% of total Billed Charges,204,85,,163.2,percent of total Billed Charges,85% of total Billed Charges,192,80,,153.6,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,151.2,63,,120.96,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,151.2,63,,120.96,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,192,80,,153.6,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,151.2,204,
99235 HOSP INPT OR OBS CARE ADMIT/DC SAME DAY MODERATE 70 MIN ProFee,99235,CDM,521,RC,99235,HCPCS,Outpatient,,,240,168,,192,80,,153.6,percent of total Billed Charges,80% of Total Billed Charges,151.2,63,,120.96,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,151.2,63,,120.96,percent of total Billed Charges,63% of total Billed Charges,204,85,,163.2,percent of total Billed Charges,85% of total Billed Charges,192,80,,153.6,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,151.2,63,,120.96,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,151.2,63,,120.96,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,192,80,,153.6,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,151.2,204,
99236 HOSP INPT OR OBS CARE ADMIT/DC SAME DAY HIGH 85 MIN ProFee,99236,CDM,521,RC,99236,HCPCS,Outpatient,,,309,216.3,,247.2,80,,197.76,percent of total Billed Charges,80% of Total Billed Charges,194.67,63,,155.736,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,194.67,63,,155.736,percent of total Billed Charges,63% of total Billed Charges,262.65,85,,210.12,percent of total Billed Charges,85% of total Billed Charges,247.2,80,,197.76,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,194.67,63,,155.736,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,194.67,63,,155.736,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,247.2,80,,197.76,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,262.65,
99236 HOSP INPT OR OBS CARE ADMIT/DC SAME DAY HIGH 85 MIN ProFee,99236,CDM,521,RC,99236,HCPCS,Outpatient,,,309,216.3,,247.2,80,,197.76,percent of total Billed Charges,80% of Total Billed Charges,194.67,63,,155.736,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,194.67,63,,155.736,percent of total Billed Charges,63% of total Billed Charges,262.65,85,,210.12,percent of total Billed Charges,85% of total Billed Charges,247.2,80,,197.76,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,194.67,63,,155.736,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,194.67,63,,155.736,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,247.2,80,,197.76,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,262.65,
99238 HOSP INPT OR OBS DSCHG DAY MGMT 30 MIN OR LESS ProFee,99238,CDM,521,RC,99238,HCPCS,Outpatient,,,103,72.1,,82.4,80,,65.92,percent of total Billed Charges,80% of Total Billed Charges,64.89,63,,51.912,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,64.89,63,,51.912,percent of total Billed Charges,63% of total Billed Charges,87.55,85,,70.04,percent of total Billed Charges,85% of total Billed Charges,82.4,80,,65.92,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,64.89,63,,51.912,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,64.89,63,,51.912,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,82.4,80,,65.92,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,64.89,190.02,
99238 HOSP INPT OR OBS DSCHG DAY MGMT 30 MIN OR LESS ProFee,99238,CDM,521,RC,99238,HCPCS,Outpatient,,,103,72.1,,82.4,80,,65.92,percent of total Billed Charges,80% of Total Billed Charges,64.89,63,,51.912,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,64.89,63,,51.912,percent of total Billed Charges,63% of total Billed Charges,87.55,85,,70.04,percent of total Billed Charges,85% of total Billed Charges,82.4,80,,65.92,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,64.89,63,,51.912,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,64.89,63,,51.912,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,82.4,80,,65.92,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,64.89,190.02,
99239 HOSP INPT OR OBS DSCHG DAY MGMT >30 MIN ProFee,99239,CDM,521,RC,99239,HCPCS,Outpatient,,,152,106.4,,121.6,80,,97.28,percent of total Billed Charges,80% of Total Billed Charges,95.76,63,,76.608,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,95.76,63,,76.608,percent of total Billed Charges,63% of total Billed Charges,129.2,85,,103.36,percent of total Billed Charges,85% of total Billed Charges,121.6,80,,97.28,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,95.76,63,,76.608,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,95.76,63,,76.608,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,121.6,80,,97.28,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,95.76,190.02,
99239 HOSP INPT OR OBS DSCHG DAY MGMT >30 MIN ProFee,99239,CDM,521,RC,99239,HCPCS,Outpatient,,,152,106.4,QW,121.6,80,,97.28,percent of total Billed Charges,80% of Total Billed Charges,95.76,63,,76.608,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,95.76,63,,76.608,percent of total Billed Charges,63% of total Billed Charges,129.2,85,,103.36,percent of total Billed Charges,85% of total Billed Charges,121.6,80,,97.28,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,95.76,63,,76.608,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,95.76,63,,76.608,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,121.6,80,,97.28,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,95.76,190.02,
99304 INITIAL NSG FACILITY LOW 25 MIN ProFee,99304,CDM,524,RC,99304,HCPCS,Outpatient,,,128,89.6,,102.4,80,,81.92,percent of total Billed Charges,80% of Total Billed Charges,80.64,63,,64.512,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,80.64,63,,64.512,percent of total Billed Charges,63% of total Billed Charges,108.8,85,,87.04,percent of total Billed Charges,85% of total Billed Charges,102.4,80,,81.92,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,80.64,63,,64.512,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,80.64,63,,64.512,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,102.4,80,,81.92,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,80.64,190.02,
99304 INITIAL NSG FACILITY LOW 25 MIN ProFee,99304,CDM,524,RC,99304,HCPCS,Outpatient,,,128,89.6,,102.4,80,,81.92,percent of total Billed Charges,80% of Total Billed Charges,80.64,63,,64.512,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,80.64,63,,64.512,percent of total Billed Charges,63% of total Billed Charges,108.8,85,,87.04,percent of total Billed Charges,85% of total Billed Charges,102.4,80,,81.92,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,80.64,63,,64.512,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,80.64,63,,64.512,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,102.4,80,,81.92,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,80.64,190.02,
99305 INITIAL NSG FACILITY MODERATE 35 MIN ProFee,99305,CDM,524,RC,99305,HCPCS,Outpatient,,,183,128.1,,146.4,80,,117.12,percent of total Billed Charges,80% of Total Billed Charges,115.29,63,,92.232,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,115.29,63,,92.232,percent of total Billed Charges,63% of total Billed Charges,155.55,85,,124.44,percent of total Billed Charges,85% of total Billed Charges,146.4,80,,117.12,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,115.29,63,,92.232,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,115.29,63,,92.232,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,146.4,80,,117.12,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,115.29,190.02,
99305 INITIAL NSG FACILITY MODERATE 35 MIN ProFee,99305,CDM,524,RC,99305,HCPCS,Outpatient,,,183,128.1,,146.4,80,,117.12,percent of total Billed Charges,80% of Total Billed Charges,115.29,63,,92.232,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,115.29,63,,92.232,percent of total Billed Charges,63% of total Billed Charges,155.55,85,,124.44,percent of total Billed Charges,85% of total Billed Charges,146.4,80,,117.12,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,115.29,63,,92.232,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,115.29,63,,92.232,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,146.4,80,,117.12,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,115.29,190.02,
99306 INITIAL NSG FACILITY 45 MIN ProFee,99306,CDM,524,RC,99306,HCPCS,Outpatient,,,235,164.5,,188,80,,150.4,percent of total Billed Charges,80% of Total Billed Charges,148.05,63,,118.44,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,148.05,63,,118.44,percent of total Billed Charges,63% of total Billed Charges,199.75,85,,159.8,percent of total Billed Charges,85% of total Billed Charges,188,80,,150.4,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,148.05,63,,118.44,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,148.05,63,,118.44,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188,80,,150.4,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,148.05,199.75,
99307 SBSQ NSG FACILITY STRTFWD 10 MIN ProFee,99307,CDM,524,RC,99307,HCPCS,Outpatient,,,68,47.6,,54.4,80,,43.52,percent of total Billed Charges,80% of Total Billed Charges,42.84,63,,34.272,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,42.84,63,,34.272,percent of total Billed Charges,63% of total Billed Charges,57.8,85,,46.24,percent of total Billed Charges,85% of total Billed Charges,54.4,80,,43.52,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,42.84,63,,34.272,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,42.84,63,,34.272,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,54.4,80,,43.52,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,42.84,190.02,
99307 SBSQ NSG FACILITY STRTFWD 10 MIN ProFee,99307,CDM,524,RC,99307,HCPCS,Outpatient,,,68,47.6,,54.4,80,,43.52,percent of total Billed Charges,80% of Total Billed Charges,42.84,63,,34.272,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,42.84,63,,34.272,percent of total Billed Charges,63% of total Billed Charges,57.8,85,,46.24,percent of total Billed Charges,85% of total Billed Charges,54.4,80,,43.52,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,42.84,63,,34.272,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,42.84,63,,34.272,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,54.4,80,,43.52,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,42.84,190.02,
99308 SBSQ NSG FACILITY LOW 15 MIN ProFee,99308,CDM,524,RC,99308,HCPCS,Outpatient,,,97,67.9,,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,61.11,63,,48.888,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,61.11,63,,48.888,percent of total Billed Charges,63% of total Billed Charges,82.45,85,,65.96,percent of total Billed Charges,85% of total Billed Charges,77.6,80,,62.08,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,61.11,63,,48.888,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,61.11,63,,48.888,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,61.11,190.02,
99308 SBSQ NSG FACILITY LOW 15 MIN ProFee,99308,CDM,524,RC,99308,HCPCS,Outpatient,,,97,67.9,,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,61.11,63,,48.888,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,61.11,63,,48.888,percent of total Billed Charges,63% of total Billed Charges,82.45,85,,65.96,percent of total Billed Charges,85% of total Billed Charges,77.6,80,,62.08,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,61.11,63,,48.888,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,61.11,63,,48.888,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,61.11,190.02,
99309 SBSQ NSG FACILITY MODERATE 30 MIN ProFee,99309,CDM,524,RC,99309,HCPCS,Outpatient,,,129,90.3,,103.2,80,,82.56,percent of total Billed Charges,80% of Total Billed Charges,81.27,63,,65.016,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,81.27,63,,65.016,percent of total Billed Charges,63% of total Billed Charges,109.65,85,,87.72,percent of total Billed Charges,85% of total Billed Charges,103.2,80,,82.56,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,81.27,63,,65.016,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,81.27,63,,65.016,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,103.2,80,,82.56,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,81.27,190.02,
99309 SBSQ NSG FACILITY MODERATE 30 MIN ProFee,99309,CDM,524,RC,99309,HCPCS,Outpatient,,,129,90.3,,103.2,80,,82.56,percent of total Billed Charges,80% of Total Billed Charges,81.27,63,,65.016,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,81.27,63,,65.016,percent of total Billed Charges,63% of total Billed Charges,109.65,85,,87.72,percent of total Billed Charges,85% of total Billed Charges,103.2,80,,82.56,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,81.27,63,,65.016,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,81.27,63,,65.016,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,103.2,80,,82.56,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,81.27,190.02,
99310 SBSQ NSG FACILITY HIGH 45 MIN ProFee,99310,CDM,524,RC,99310,HCPCS,Outpatient,,,191,133.7,,152.8,80,,122.24,percent of total Billed Charges,80% of Total Billed Charges,120.33,63,,96.264,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,120.33,63,,96.264,percent of total Billed Charges,63% of total Billed Charges,162.35,85,,129.88,percent of total Billed Charges,85% of total Billed Charges,152.8,80,,122.24,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,120.33,63,,96.264,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,120.33,63,,96.264,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,152.8,80,,122.24,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,120.33,190.02,
99310 SBSQ NSG FACILITY HIGH 45 MIN ProFee,99310,CDM,524,RC,99310,HCPCS,Outpatient,,,191,133.7,,152.8,80,,122.24,percent of total Billed Charges,80% of Total Billed Charges,120.33,63,,96.264,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,120.33,63,,96.264,percent of total Billed Charges,63% of total Billed Charges,162.35,85,,129.88,percent of total Billed Charges,85% of total Billed Charges,152.8,80,,122.24,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,120.33,63,,96.264,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,120.33,63,,96.264,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,152.8,80,,122.24,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,120.33,190.02,
99316 SWINGBED DIS >30 MINS ProFee,99316,CDM,524,RC,99316,HCPCS,Outpatient,,,149,104.3,,119.2,80,,95.36,percent of total Billed Charges,80% of Total Billed Charges,93.87,63,,75.096,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,93.87,63,,75.096,percent of total Billed Charges,63% of total Billed Charges,126.65,85,,101.32,percent of total Billed Charges,85% of total Billed Charges,119.2,80,,95.36,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,93.87,63,,75.096,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,93.87,63,,75.096,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,119.2,80,,95.36,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,93.87,190.02,
99315 SWINGBED DIS <30 MINS ProFee,99315,CDM,524,RC,99315,HCPCS,Outpatient,,,102,71.4,,81.6,80,,65.28,percent of total Billed Charges,80% of Total Billed Charges,64.26,63,,51.408,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,64.26,63,,51.408,percent of total Billed Charges,63% of total Billed Charges,86.7,85,,69.36,percent of total Billed Charges,85% of total Billed Charges,81.6,80,,65.28,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,64.26,63,,51.408,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,64.26,63,,51.408,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,81.6,80,,65.28,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,64.26,190.02,
99316 SWINGBED DIS >30 MINS ProFee,99316,CDM,524,RC,99316,HCPCS,Outpatient,,,149,104.3,,119.2,80,,95.36,percent of total Billed Charges,80% of Total Billed Charges,93.87,63,,75.096,percent of total Billed charges,63% of Total Billed Charges,188.14,100,,,Case Rate,Pays based on per visit Rate ,93.87,63,,75.096,percent of total Billed Charges,63% of total Billed Charges,126.65,85,,101.32,percent of total Billed Charges,85% of total Billed Charges,119.2,80,,95.36,percent of total Billed Charges,80% of total Billed Charges,190.02,100,,,case rate,pays based on per visit rate,93.87,63,,75.096,percent of total Billed Charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,93.87,63,,75.096,percent of total billed charges,63% of total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,119.2,80,,95.36,percent of total Billed Charges,80% of Total Billed Charges,188.14,100,,,Case Rate,Pays Based on per visit Rate,188.14,100,,,Case Rate,Pays Based on per visit Rate,93.87,190.02,
insulin regular 100 units/mL human recombinant Inj,193619,CDM,636,RC,J1815,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.32,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.31,0.32,
insulin lispro 100 units/mL Injectable Soln 3 mL [,192784,CDM,636,RC,J1815,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.32,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.31,0.32,
test267,192784,CDM,636,RC,J1815,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.32,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.31,0.32,
insulin lispro 100 units/mL Injectable Soln 3 mL [,192784,CDM,636,RC,J1815,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.32,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.31,0.32,
insulin regular 100 units/mL human recombinant Inj,193619,CDM,636,RC,J1815,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.32,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.31,0.32,
test268,193619,CDM,636,RC,J1815,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.32,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.31,0.32,
test265,193540,CDM,636,RC,J1815,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.32,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.31,0.32,
test266,,,636,RC,J1815,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.32,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.31,0.32,
pneumococcal 23-polyvalent vaccine Inj Soln 0.5 mL,193534,CDM,636,RC,90732,HCPCS,Outpatient,,,,,EP,,,,,Other,Not Separately reimbursable,133.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,133.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,133.47,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,136.14,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,133.47,136.14,
test249,190952,CDM,636,RC,J1720,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,17.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,17.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.85,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,18.21,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,17.85,18.21,
test251,190954,CDM,636,RC,J1720,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,17.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,17.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,17.85,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,18.21,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,17.85,18.21,
test543,193488,CDM,636,RC,J3486,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,9.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,9.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.76,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,9.96,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,9.76,9.96,
test285,193579,CDM,636,RC,J1950,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1564.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1564.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1564.6,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1595.89,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1564.6,1595.89,
test286,193548,CDM,636,RC,J9217,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,181.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,181.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,181.3,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,184.93,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,181.3,184.93,
test264,192842,CDM,636,RC,J1815,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.32,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.31,0.32,
acetaminophen 10 mg/mL Inj [WLMH],193683,CDM,636,RC,J0137,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,0.05,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.05,0.05,
test508,190149,CDM,636,RC,J3105,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,7.79,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,7.79,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.79,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,7.95,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,7.79,7.95,
test263,193055,CDM,636,RC,J1815,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.31,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.32,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.31,0.32,
test84,193123,CDM,636,RC,J0690,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.76,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.78,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.76,0.78,
test89,193563,CDM,636,RC,J0694,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,5.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,5.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,5.18,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,5.08,5.18,
test91,193269,CDM,636,RC,J0696,HCPCS,Outpatient,,,,,EP,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.49,0.5,
test92,193306,CDM,636,RC,J0696,HCPCS,Outpatient,,,,,EP,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.49,0.5,
test344,193516,CDM,636,RC,J2184,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,2.11,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,2.11,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.11,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,2.15,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,2.11,2.15,
test343,193517,CDM,636,RC,J2184,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,2.11,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,2.11,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.11,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,2.15,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,2.11,2.15,
ketorolac 30 mg/mL Inj Soln 1 mL [WLMH],191473,CDM,636,RC,J1885,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.49,0.5,
test302,191861,CDM,636,RC,J2001,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,0.03,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.03,0.03,
test225,193558,CDM,636,RC,J1580,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,2.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,2.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,2.74,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,2.69,2.74,
dextrose 5% in water with KCl 20 mEq/L IV Soln 100,193292,CDM,636,RC,J3480,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.12,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.12,0.12,
test443,193009,CDM,636,RC,J3480,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.12,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.12,0.12,
test366,190392,CDM,636,RC,J1836,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,0.02,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.02,0.02,
DOBUTamine 250 mg/250 mL IV Soln [WLMH],193677,CDM,636,RC,J1250,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,9.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,9.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.85,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,10.05,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,9.85,10.05,
DOBUTamine 500 mg/D5W 250 mL [WLMH],193677,CDM,636,RC,J1250,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,9.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,9.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.85,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,10.05,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,9.85,10.05,
magnesium sulfate 40 mg/mL IV Soln 50 mL [WLMH],193549,CDM,636,RC,J3475,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.69,0.7,
metroNIDAZOLE 500 mg/100 mL IV Soln 100 mL [WLMH],190392,CDM,636,RC,J1836,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,0.02,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.02,0.02,
bupivacaine 0.25% PF Inj Soln 10 mL [WLMH],193336,CDM,636,RC,J0665,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,0.01,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.01,0.01,
bupivacaine 0.5% PF Inj Soln 10 mL [WLMH],191777,CDM,636,RC,J0665,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,0.01,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.01,0.01,
test224,190416,CDM,636,RC,J1580,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,2.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,2.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,2.74,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,2.69,2.74,
diazePAM 5 mg/mL Inj Soln 2 mL [WLMH],191097,CDM,636,RC,J3360,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,5.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,5.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.47,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,5.58,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,5.47,5.58,
test253,190304,CDM,636,RC,J1170,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,4.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,4.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.59,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,4.68,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,4.59,4.68,
atropine 0.1 mg/mL IV Soln 10 mL [WLMH],191364,CDM,636,RC,J0461,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.08,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.08,0.08,
midaSol,8772379,CDM,636,RC,J2250,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.14,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.14,0.14,
DOBUTamine 12.5 mg/mL IV Soln 20 mL [WLMH],193453,CDM,636,RC,J1250,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,9.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,9.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.85,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,10.05,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,9.85,10.05,
DOBUTamine 250 mg/250 mL IV Soln [WLMH],193677,CDM,636,RC,J1250,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,9.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,9.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.85,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,10.05,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,9.85,10.05,
test158,193677,CDM,636,RC,J1250,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,9.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,9.85,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.85,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,10.05,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,9.85,10.05,
test436,191951,CDM,636,RC,J2543,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.18,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.2,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.18,1.2,
metoclopramide 5 mg/mL Inj Soln 2 mL [WLMH],190894,CDM,636,RC,J2765,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.09,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.11,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.09,1.11,
test358,190894,CDM,636,RC,J2765,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.09,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.11,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.09,1.11,
ketorolac 30 mg/mL Inj Soln 1 mL [WLMH],191473,CDM,636,RC,J1885,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.49,0.5,
EPINEPHrine 0.1 mg/mL Inj Soln 10 mL Syr [WLMH],190367,CDM,636,RC,J0171,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.75,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.77,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.75,0.77,
cefTRIAXone 1 g Inj [WLMH],190915,CDM,636,RC,J0696,HCPCS,Outpatient,,,,,EP,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.49,0.5,
test93,191160,CDM,636,RC,J0696,HCPCS,Outpatient,,,,,EP,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.49,0.5,
test94,191261,CDM,636,RC,J0696,HCPCS,Outpatient,,,,,EP,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.49,0.5,
hepaSol,9142617,CDM,636,RC,J1644,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.27,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.28,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.27,0.28,
heparin 100 units/mL-NaCl 0.45% 250mL IVPB [WLMH],9142617,CDM,636,RC,J1644,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.27,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.28,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.27,0.28,
test133,193292,CDM,636,RC,J3480,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.12,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.12,0.12,
test197,193664,CDM,636,RC,J3010,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.97,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.99,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.97,0.99,
test198,192782,CDM,636,RC,J3010,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.97,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.99,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.97,0.99,
fentaNYL 50 mcg/mL Inj Soln 2 mL Vial [WLMH],192782,CDM,636,RC,J3010,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.97,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.99,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.97,0.99,
test199,193655,CDM,636,RC,J3010,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.97,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.99,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.97,0.99,
test48,191425,CDM,636,RC,J0461,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.08,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.08,0.08,
test118,190245,CDM,636,RC,J3420,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.44,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.44,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.44,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.47,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.44,1.47,
test270,193018,CDM,636,RC,J1756,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.22,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.22,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.22,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.22,0.22,
glucagon recombinant 1 mg Inj [WLMH],190418,CDM,636,RC,J1610,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,188.37,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,188.37,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,188.37,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,192.14,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,188.37,192.14,
test117,192021,CDM,636,RC,J0834,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,27.11,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,27.11,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.11,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,27.65,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,27.11,27.65,
test228,190418,CDM,636,RC,J1610,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,188.37,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,188.37,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,188.37,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,192.14,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,188.37,192.14,
diphenhydrAMINE 50 mg/mL Inj Soln 1 mL [WLMH],190130,CDM,636,RC,J1200,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.8,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.82,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.8,0.82,
heparin 5000 units/mL Inj Soln 1 mL [WLMH],190438,CDM,636,RC,J1644,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.27,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.28,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.27,0.28,
test455,190807,CDM,636,RC,J2550,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,3.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,3.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.59,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,3.66,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,3.59,3.66,
digoxin 250 mcg/mL (0.25 mg/mL) Inj Soln 2 mL [WLM,190563,CDM,636,RC,J1160,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,9.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,9.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.41,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,9.6,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,9.41,9.6,
test341,,,636,RC,J2175,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,7.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,7.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.3,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,7.45,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,7.3,7.45,
test342,,,636,RC,J2175,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,7.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,7.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.3,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,7.45,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,7.3,7.45,
mida1Sol,8800682,CDM,636,RC,J2250,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.14,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.14,0.14,
test371,191760,CDM,636,RC,J2250,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.14,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.14,0.14,
midazolam 5 mg/mL Inj Soln 2 mL [WLMH],191107,CDM,636,RC,J2250,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.14,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.14,0.14,
midazolam 5 mg/mL Inj Soln [WLMH],191107,CDM,636,RC,J2250,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.14,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.14,0.14,
test372,191107,CDM,636,RC,J2250,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.14,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.14,0.14,
test379,193511,CDM,636,RC,J2270,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,4.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,4.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.67,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,4.76,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,4.67,4.76,
test377,190669,CDM,636,RC,J2270,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,4.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,4.67,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,4.67,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,4.76,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,4.67,4.76,
test428,191766,CDM,636,RC,J2371,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,0.01,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.01,0.01,
test409,191658,CDM,636,RC,J2360,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,9.71,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,9.71,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.71,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,9.9,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,9.71,9.9,
promethazine 25 mg/mL Inj Soln 1 mL [WLMH],190807,CDM,636,RC,J2550,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,3.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,3.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.59,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,3.66,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,3.59,3.66,
hydrALAZINE 20 mg/mL Inj Soln 1 mL [WLMH],190083,CDM,636,RC,J0360,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,5.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,5.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.59,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,5.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,5.59,5.7,
test146,190563,CDM,636,RC,J1160,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,9.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,9.41,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.41,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,9.6,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,9.41,9.6,
test102,192005,CDM,636,RC,J0736,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.9,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.94,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.9,1.94,
test103,192006,CDM,636,RC,J0736,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.9,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.94,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.9,1.94,
potassium chloride 20 mEq/100 mL IV Soln 100 mL [W,193009,CDM,636,RC,J3480,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.12,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.12,0.12,
test444,193663,CDM,636,RC,J3480,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.12,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.12,0.12,
test239,193261,CDM,636,RC,J1642,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,0.02,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.02,0.02,
heparin flush 100 units/mL IV Soln 5 mL [WLMH],193261,CDM,636,RC,J1642,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,0.02,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.02,0.02,
furosemide 10 mg/mL Inj Soln 4 mL [WLMH],190570,CDM,636,RC,J1940,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.58,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.57,0.58,
orphenadrine 30 mg/mL Inj Soln 2 mL [WLMH],191658,CDM,636,RC,J2360,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,9.71,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,9.71,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.71,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,9.9,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,9.71,9.9,
adenosine 3 mg/mL IV Soln 2 mL [WLMH],191628,CDM,636,RC,J0153,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.6,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.61,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.6,0.61,
test11,191628,CDM,636,RC,J0153,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.6,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.61,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.6,0.61,
midazolam 1 mg/mL Inj Soln 2 mL [WLMH],191760,CDM,636,RC,J2250,HCPCS,Outpatient,,,,,EP,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.14,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.14,0.14,
metroNIDAZOLE 500 mg/100 mL IV Soln 100 mL [WLMH],190392,CDM,636,RC,J1836,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,0.02,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.02,0.02,
test37,191188,CDM,636,RC,J0295,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.77,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.81,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.77,1.81,
fluconazole 200 mg/NaCl 0.9% 100 mL [WLMH],191465,CDM,636,RC,J1450,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,2.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,2.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.8,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,2.86,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,2.8,2.86,
micafungin 100 mg IV Inj [WLMH],193648,CDM,636,RC,J2248,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.76,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.78,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.76,0.78,
test215,190569,CDM,636,RC,J1940,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.58,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.57,0.58,
test216,190570,CDM,636,RC,J1940,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.58,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.57,0.58,
test214,191367,CDM,636,RC,J1940,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.57,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.57,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.58,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.57,0.58,
test178,190366,CDM,636,RC,J0171,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.75,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.77,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.75,0.77,
test179,191438,CDM,636,RC,J0171,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.75,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.77,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.75,0.77,
test386,193215,CDM,636,RC,J2710,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.8,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.82,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.8,0.82,
test182,193096,CDM,636,RC,J1335,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,12.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,12.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.97,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,13.23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,12.97,13.23,
test433,192976,CDM,636,RC,J3430,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,2.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,2.9,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.9,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,2.96,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,2.9,2.96,
ziprasidone 20 mg IM Inj [WLMH],193488,CDM,636,RC,J3486,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,9.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,9.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,9.76,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,9.96,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,9.76,9.96,
ampicillin-sulbactam 1 g-0.5 g Inj [WLMH],191188,CDM,636,RC,J0295,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.77,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.81,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.77,1.81,
test76,193635,CDM,636,RC,J0613,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.09,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.09,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.09,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.09,0.09,
cefTRIAXone 1 g Inj [WLMH],190915,CDM,636,RC,J0696,HCPCS,Outpatient,,,,,EP,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.49,0.5,
test83,190069,CDM,636,RC,J0690,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.76,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.78,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.76,0.78,
piperacillin-tazobactam 3 g-0.375 g IV Inj [WLMH],192012,CDM,636,RC,J2543,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.18,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.2,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.18,1.2,
ertapenem 1 g Inj [WLMH],193096,CDM,636,RC,J1335,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,12.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,12.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.97,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,13.23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,12.97,13.23,
"influenza virus vaccine, inactivated preservative-",193651,CDM,636,RC,90686,HCPCS,Outpatient,,,,,EP,,,,,Other,Not Separately reimbursable,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,22.35,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,22.35,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,22.8,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,22.35,22.8,
test348,190639,CDM,636,RC,J2210,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,19.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,19.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,19.6,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,19.99,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,19.6,19.99,
test544,193567,CDM,636,RC,J3489,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,7.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,7.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.21,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,7.35,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,7.21,7.35,
ampicillin-sulbactam 2 g-1 g Inj [WLMH],191196,CDM,636,RC,J0295,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.77,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.81,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.77,1.81,
test435,192012,CDM,636,RC,J2543,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.18,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.2,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.18,1.2,
test10,193555,CDM,636,RC,J0133,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.06,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.06,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.06,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.06,0.06,
test68,193336,CDM,636,RC,J0665,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,0.01,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.01,0.01,
test69,191777,CDM,636,RC,J0665,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,0.01,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.01,0.01,
linezolid 2 mg/mL IV Soln 300 mL [WLMH],192818,CDM,636,RC,J2020,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,3.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,3.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.3,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,3.37,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,3.3,3.37,
naloxone 1 mg/mL Inj Soln 2 mL [WLMH],190694,CDM,636,RC,J2310,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,7.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,7.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.29,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,7.44,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,7.29,7.44,
test125,193556,CDM,636,RC,J0897,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,25.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,25.2,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.2,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,25.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,25.2,25.7,
test121,193554,CDM,636,RC,J0875,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,15.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,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,15.29,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,15.6,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,15.29,15.6,
hepatitis B adult vaccine 20 mcg/mL IM Susp 1 mL [,191903,CDM,636,RC,90746,HCPCS,Outpatient,,,,,EP,,,,,Other,Not Separately reimbursable,70.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,70.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,70.38,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,71.79,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,70.38,71.79,
test240,191903,CDM,636,RC,90746,HCPCS,Outpatient,,,,,EP,,,,,Other,Not Separately reimbursable,70.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,70.38,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,70.38,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,71.79,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,70.38,71.79,
test41,193557,CDM,636,RC,J0402,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,5.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,5.88,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.88,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,6,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,5.88,6,
test406,192933,CDM,636,RC,J2405,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.1,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.1,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.1,0.1,
test90,190915,CDM,636,RC,J0696,HCPCS,Outpatient,,,,,EP,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.49,0.5,
cefTRIAXone 250 mg Inj [WLMH],191160,CDM,636,RC,J0696,HCPCS,Outpatient,,,,,EP,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.49,0.5,
cefTRIAXone 500 mg Inj [WLMH],191261,CDM,636,RC,J0696,HCPCS,Outpatient,,,,,EP,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.49,0.5,
piperacillin-tazobactam 4 g-0.5 g IV Inj [WLMH],191951,CDM,636,RC,J2543,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.18,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.18,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.2,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.18,1.2,
ertapenem 1 g Inj [WLMH],193096,CDM,636,RC,J1335,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,12.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,12.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,12.97,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,13.23,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,12.97,13.23,
test521,190545,CDM,636,RC,J3301,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.95,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.95,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.97,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.95,0.97,
ketorolac 30 mg/mL Inj Soln 1 mL [WLMH],191473,CDM,636,RC,J1885,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.49,0.5,
test287,193580,CDM,636,RC,J9217,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,181.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,181.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,181.3,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,184.93,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,181.3,184.93,
gentamicin 40 mg/mL Inj Soln 2 mL [WLMH],190416,CDM,636,RC,J1580,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,2.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,2.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,2.74,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,2.69,2.74,
magn50Sol,190614,CDM,636,RC,J3475,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.69,0.7,
test334,193549,CDM,636,RC,J3475,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.69,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.69,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.69,0.7,
test277,191473,CDM,636,RC,J1885,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.49,0.5,
test278,191533,CDM,636,RC,J1885,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.49,0.5,
dexamethasone 4 mg/mL Inj Soln 1 mL [WLMH],193603,CDM,636,RC,J1100,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.12,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.12,0.12,
protamine 10 mg/mL Inj Soln 25 mL [WLMH],190877,CDM,636,RC,J2720,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.66,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.69,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.66,1.69,
test461,190877,CDM,636,RC,J2720,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.66,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.66,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.69,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.66,1.69,
test238,190438,CDM,636,RC,J1644,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.27,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.27,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.28,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.27,0.28,
test503,191666,CDM,636,RC,J3030,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,62.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,62.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62.75,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,64.01,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,62.75,64.01,
imipenem-cilastatin 500 mg Inj [WLMH],193483,CDM,636,RC,J0743,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,8.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,8.1,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.1,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,8.26,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,8.1,8.26,
acet10Sol,193683,CDM,636,RC,J0137,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,0.05,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.05,0.05,
morpSol,191862,CDM,636,RC,J2272,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,7.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,7.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.43,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,7.58,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,7.43,7.58,
test236,193600,CDM,636,RC,J1630,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.42,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.45,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.42,1.45,
test124,190277,CDM,636,RC,J0895,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,8.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,8.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.6,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,8.77,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,8.6,8.77,
test242,190083,CDM,636,RC,J0360,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,5.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,5.59,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.59,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,5.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,5.59,5.7,
adenosine 3 mg/mL IV Soln 2 mL [WLMH],191628,CDM,636,RC,J0153,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.6,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.61,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.6,0.61,
test154,190130,CDM,636,RC,J1200,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.8,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.82,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.8,0.82,
test318,192818,CDM,636,RC,J2020,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,3.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,3.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.3,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,3.37,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,3.3,3.37,
phenylephrine 10 mg/mL Inj Soln 1 mL Vial [WLMH],193486,CDM,636,RC,J2371,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,0.01,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.01,0.01,
test196,,,636,RC,J3010,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.97,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.97,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.99,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.97,0.99,
heparin flush 100 units/mL IV Soln 5 mL [WLMH],193261,CDM,636,RC,J1642,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,0.02,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.02,0.02,
linezolid 2 mg/mL IV Soln 300 mL [WLMH],192818,CDM,636,RC,J2020,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,3.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,3.3,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,3.3,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,3.37,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,3.3,3.37,
test526,193680,CDM,636,RC,J3370,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,2.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,2.31,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.31,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,2.36,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,2.31,2.36,
test38,191196,CDM,636,RC,J0295,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.77,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.77,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.81,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.77,1.81,
test36,190057,CDM,636,RC,J0290,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.01,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.01,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.01,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.03,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.01,1.03,
zoledronic acid 5 mg/100 mL IV Soln 100 mL [WLMH],193567,CDM,636,RC,J3489,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,7.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,7.21,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.21,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,7.35,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,7.21,7.35,
test123,193179,CDM,636,RC,J0878,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,0.04,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.04,0.04,
adenosine 3 mg/mL IV Soln 2 mL [WLMH],191628,CDM,636,RC,J0153,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.6,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.6,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.61,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.6,0.61,
ampicillin 1 g Inj [WLMH],190057,CDM,636,RC,J0290,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.01,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.01,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.01,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.03,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.01,1.03,
ketorolac 30 mg/mL Inj Soln 1 mL [WLMH],191473,CDM,636,RC,J1885,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.49,0.5,
test142,191097,CDM,636,RC,J3360,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,5.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,5.47,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.47,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,5.58,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,5.47,5.58,
test204,191465,CDM,636,RC,J1450,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,2.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,2.8,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,2.8,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,2.86,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,2.8,2.86,
test531,193544,CDM,636,RC,J3372,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.58,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,6.71,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,6.58,6.71,
test527,193539,CDM,636,RC,J3372,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.58,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,6.71,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,6.58,6.71,
test529,193547,CDM,636,RC,J3372,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.58,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,6.71,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,6.58,6.71,
test122,193543,CDM,636,RC,J0878,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,0.04,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.04,0.04,
test532,193633,CDM,636,RC,J3372,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.58,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,6.71,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,6.58,6.71,
test528,193632,CDM,636,RC,J3372,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,6.58,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,6.58,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,6.71,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,6.58,6.71,
DAPTOmycin 500 mg IV Inj [WLMH],193179,CDM,636,RC,J0878,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,0.04,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.04,0.04,
DAPTOmycin 350 mg IV Inj [WLMH],193543,CDM,636,RC,J0878,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,0.04,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.04,0.04,
micafungin 100 mg IV Inj [WLMH],193648,CDM,636,RC,J2248,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.76,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.76,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.78,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.76,0.78,
ketorolac 60 mg/2 mL IM Soln [WLMH],191533,CDM,636,RC,J1885,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.49,0.5,
midazolam 1 mg/mL Inj Soln  [WLMH],191760,CDM,636,RC,J2250,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.14,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.14,0.14,
midazolam 5 mg/mL Inj Soln [WLMH],191107,CDM,636,RC,J2250,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.14,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.14,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.14,0.14,
test429,193486,CDM,636,RC,J2371,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,0.01,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.01,0.01,
morpSol,191862,CDM,636,RC,J2272,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,7.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,7.43,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.43,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,7.58,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,7.43,7.58,
ketorolac 30 mg/mL Inj Soln 1 mL [WLMH],191473,CDM,636,RC,J1885,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.49,0.5,
ketorolac 60 mg/2 mL IM Soln [WLMH],191533,CDM,636,RC,J1885,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.49,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.5,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.49,0.5,
test126,193603,CDM,636,RC,J1100,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.12,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.12,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.12,0.12,
test237,,,636,RC,J1630,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.42,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.45,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.42,1.45,
haloperidol 5 mg/mL Inj Soln [WLMH],193600,CDM,636,RC,J1630,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,1.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,1.42,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,1.42,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,1.45,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,1.42,1.45,
test177,190367,CDM,636,RC,J0171,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.75,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.77,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.75,0.77,
EPINEPHrine 0.1 mg/mL Inj Soln 10 mL Syr [WLMH],190367,CDM,636,RC,J0171,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.75,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.75,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.77,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.75,0.77,
test49,191364,CDM,636,RC,J0461,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,0.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,0.08,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,0.08,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,0.08,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,0.08,0.08,
test384,190694,CDM,636,RC,J2310,HCPCS,Outpatient,,,,,,,,,,Other,Not Separately reimbursable,7.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,7.29,100,,,Fee Schedule,100% of GA Medicaid Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.29,100,,,Fee Schedule,100% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,7.44,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,7.29,7.44,
J0897 - 60 mg/1ml inj denosumab,193556,CDM,636,RC,,,Outpatient,,,3545.2,2481.64,,2836.16,80,,2268.928,percent of total Billed Charges,80% of Total Billed Charges,2233.48,63,,1786.784,percent of total Billed charges,63% of Total Billed Charges,2198.02,62,,1758.416,percent of total Billed Charges,62% of total BIlled charges,2233.48,63,,1786.784,percent of total Billed Charges,63% of total Billed Charges,3013.42,85,,2410.736,percent of total Billed Charges,85% of total Billed Charges,2836.16,80,,2268.928,percent of total Billed Charges,80% of total Billed Charges,2198.02,62,,1758.416,percent of total Billed Charges,62% of total Billed Charges,2233.48,63,,1786.784,percent of total Billed Charges,63% of total Billed Charges,2198.02,62,,1758.416,percent of total Billed Charges,62% of total Billed Charges,2233.48,63,,1786.784,percent of total billed charges,63% of total Billed Charges,2198.02,62,,1758.416,percent of total Billed Charges,62% of total Billed Charges,2836.16,80,,2268.928,percent of total Billed Charges,80% of Total Billed Charges,2198.02,62,,1758.416,percent of total Billed Charges,62% of total Billed Charges,2198.02,62,,1758.416,percent of total Billed Charges,62% of total Billed Charges,2198.02,3013.42,
93005 Electrocardiogram 12 Lead,150136,CDM,730,RC,93005,HCPCS,Outpatient,,,97,67.9,,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,61.11,63,,48.888,percent of total Billed charges,63% of Total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total BIlled charges,61.11,63,,48.888,percent of total Billed Charges,63% of total Billed Charges,82.45,85,,65.96,percent of total Billed Charges,85% of total Billed Charges,77.6,80,,62.08,percent of total Billed Charges,80% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,61.11,63,,48.888,percent of total Billed Charges,63% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,61.11,63,,48.888,percent of total billed charges,63% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,60.14,82.45,
EKG,100003,CDM,730,RC,93005,HCPCS,Outpatient,,,97,67.9,,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,61.11,63,,48.888,percent of total Billed charges,63% of Total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total BIlled charges,61.11,63,,48.888,percent of total Billed Charges,63% of total Billed Charges,82.45,85,,65.96,percent of total Billed Charges,85% of total Billed Charges,77.6,80,,62.08,percent of total Billed Charges,80% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,61.11,63,,48.888,percent of total Billed Charges,63% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,61.11,63,,48.888,percent of total billed charges,63% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,60.14,82.45,
93005 EKG - ER TechFee,150136,CDM,730,RC,93005,HCPCS,Outpatient,,,97,67.9,,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,61.11,63,,48.888,percent of total Billed charges,63% of Total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total BIlled charges,61.11,63,,48.888,percent of total Billed Charges,63% of total Billed Charges,82.45,85,,65.96,percent of total Billed Charges,85% of total Billed Charges,77.6,80,,62.08,percent of total Billed Charges,80% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,61.11,63,,48.888,percent of total Billed Charges,63% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,61.11,63,,48.888,percent of total billed charges,63% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,60.14,82.45,
Electrocardiogram,10003,CDM,730,RC,93005,HCPCS,Outpatient,,,97,67.9,,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,61.11,63,,48.888,percent of total Billed charges,63% of Total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total BIlled charges,61.11,63,,48.888,percent of total Billed Charges,63% of total Billed Charges,82.45,85,,65.96,percent of total Billed Charges,85% of total Billed Charges,77.6,80,,62.08,percent of total Billed Charges,80% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,61.11,63,,48.888,percent of total Billed Charges,63% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,61.11,63,,48.888,percent of total billed charges,63% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,60.14,82.45,
93005 - RT Electrocardiogram (EKG) CHARGE,150136,CDM,730,RC,93005,HCPCS,Outpatient,,,97,67.9,,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,61.11,63,,48.888,percent of total Billed charges,63% of Total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total BIlled charges,61.11,63,,48.888,percent of total Billed Charges,63% of total Billed Charges,82.45,85,,65.96,percent of total Billed Charges,85% of total Billed Charges,77.6,80,,62.08,percent of total Billed Charges,80% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,61.11,63,,48.888,percent of total Billed Charges,63% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,61.11,63,,48.888,percent of total billed charges,63% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,60.14,82.45,
93225 HOLTER MONITOR CHARGE < 48 HRS,150139,CDM,731,RC,93225,HCPCS,Outpatient,,,244,170.8,,195.2,80,,156.16,percent of total Billed Charges,80% of Total Billed Charges,153.72,63,,122.976,percent of total Billed charges,63% of Total Billed Charges,151.28,62,,121.024,percent of total Billed Charges,62% of total BIlled charges,153.72,63,,122.976,percent of total Billed Charges,63% of total Billed Charges,207.4,85,,165.92,percent of total Billed Charges,85% of total Billed Charges,195.2,80,,156.16,percent of total Billed Charges,80% of total Billed Charges,151.28,62,,121.024,percent of total Billed Charges,62% of total Billed Charges,153.72,63,,122.976,percent of total Billed Charges,63% of total Billed Charges,151.28,62,,121.024,percent of total Billed Charges,62% of total Billed Charges,153.72,63,,122.976,percent of total billed charges,63% of total Billed Charges,151.28,62,,121.024,percent of total Billed Charges,62% of total Billed Charges,195.2,80,,156.16,percent of total Billed Charges,80% of Total Billed Charges,151.28,62,,121.024,percent of total Billed Charges,62% of total Billed Charges,151.28,62,,121.024,percent of total Billed Charges,62% of total Billed Charges,151.28,207.4,
93227 Cardiac Monitoring Interp  and Review,150142,CDM,731,RC,93227,HCPCS,Outpatient,,,70,49,,56,80,,44.8,percent of total Billed Charges,80% of Total Billed Charges,44.1,63,,35.28,percent of total Billed charges,63% of Total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total BIlled charges,44.1,63,,35.28,percent of total Billed Charges,63% of total Billed Charges,59.5,85,,47.6,percent of total Billed Charges,85% of total Billed Charges,56,80,,44.8,percent of total Billed Charges,80% of total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total Billed Charges,44.1,63,,35.28,percent of total Billed Charges,63% of total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total Billed Charges,44.1,63,,35.28,percent of total billed charges,63% of total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total Billed Charges,56,80,,44.8,percent of total Billed Charges,80% of Total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total Billed Charges,43.4,62,,34.72,percent of total Billed Charges,62% of total Billed Charges,43.4,59.5,
93228 Mobile Cardiac Telemetry,150145,CDM,731,RC,93228,HCPCS,Outpatient,,,95,66.5,,76,80,,60.8,percent of total Billed Charges,80% of Total Billed Charges,59.85,63,,47.88,percent of total Billed charges,63% of Total Billed Charges,58.9,62,,47.12,percent of total Billed Charges,62% of total BIlled charges,59.85,63,,47.88,percent of total Billed Charges,63% of total Billed Charges,80.75,85,,64.6,percent of total Billed Charges,85% of total Billed Charges,76,80,,60.8,percent of total Billed Charges,80% of total Billed Charges,58.9,62,,47.12,percent of total Billed Charges,62% of total Billed Charges,59.85,63,,47.88,percent of total Billed Charges,63% of total Billed Charges,58.9,62,,47.12,percent of total Billed Charges,62% of total Billed Charges,59.85,63,,47.88,percent of total billed charges,63% of total Billed Charges,58.9,62,,47.12,percent of total Billed Charges,62% of total Billed Charges,76,80,,60.8,percent of total Billed Charges,80% of Total Billed Charges,58.9,62,,47.12,percent of total Billed Charges,62% of total Billed Charges,58.9,62,,47.12,percent of total Billed Charges,62% of total Billed Charges,58.9,80.75,
93242 EXT ECG RCDG MORE THAN 48HRS  UP TO 7 DAYS,150140,CDM,731,RC,93242,HCPCS,Outpatient,,,77,53.9,,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,48.51,63,,38.808,percent of total Billed charges,63% of Total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total BIlled charges,48.51,63,,38.808,percent of total Billed Charges,63% of total Billed Charges,65.45,85,,52.36,percent of total Billed Charges,85% of total Billed Charges,61.6,80,,49.28,percent of total Billed Charges,80% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,48.51,63,,38.808,percent of total Billed Charges,63% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,48.51,63,,38.808,percent of total billed charges,63% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,47.74,65.45,
93244 Interp ecg recorder >48 hrs up to 7 days,150143,CDM,731,RC,93244,HCPCS,Outpatient,,,88,61.6,,70.4,80,,56.32,percent of total Billed Charges,80% of Total Billed Charges,55.44,63,,44.352,percent of total Billed charges,63% of Total Billed Charges,54.56,62,,43.648,percent of total Billed Charges,62% of total BIlled charges,55.44,63,,44.352,percent of total Billed Charges,63% of total Billed Charges,74.8,85,,59.84,percent of total Billed Charges,85% of total Billed Charges,70.4,80,,56.32,percent of total Billed Charges,80% of total Billed Charges,54.56,62,,43.648,percent of total Billed Charges,62% of total Billed Charges,55.44,63,,44.352,percent of total Billed Charges,63% of total Billed Charges,54.56,62,,43.648,percent of total Billed Charges,62% of total Billed Charges,55.44,63,,44.352,percent of total billed charges,63% of total Billed Charges,54.56,62,,43.648,percent of total Billed Charges,62% of total Billed Charges,70.4,80,,56.32,percent of total Billed Charges,80% of Total Billed Charges,54.56,62,,43.648,percent of total Billed Charges,62% of total Billed Charges,54.56,62,,43.648,percent of total Billed Charges,62% of total Billed Charges,54.56,74.8,
93246 EXT ECG RCDG MORE THAN 7 DAYS -15 DAYS,150141,CDM,731,RC,93246,HCPCS,Outpatient,,,77,53.9,,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,48.51,63,,38.808,percent of total Billed charges,63% of Total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total BIlled charges,48.51,63,,38.808,percent of total Billed Charges,63% of total Billed Charges,65.45,85,,52.36,percent of total Billed Charges,85% of total Billed Charges,61.6,80,,49.28,percent of total Billed Charges,80% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,48.51,63,,38.808,percent of total Billed Charges,63% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,48.51,63,,38.808,percent of total billed charges,63% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,47.74,65.45,
93248 Interp ecg recording >7 days up to 15 days,150144,CDM,731,RC,93248,HCPCS,Outpatient,,,97,67.9,,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,61.11,63,,48.888,percent of total Billed charges,63% of Total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total BIlled charges,61.11,63,,48.888,percent of total Billed Charges,63% of total Billed Charges,82.45,85,,65.96,percent of total Billed Charges,85% of total Billed Charges,77.6,80,,62.08,percent of total Billed Charges,80% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,61.11,63,,48.888,percent of total Billed Charges,63% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,61.11,63,,48.888,percent of total billed charges,63% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,77.6,80,,62.08,percent of total Billed Charges,80% of Total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,60.14,62,,48.112,percent of total Billed Charges,62% of total Billed Charges,60.14,82.45,
36592 - Blood drawn,220159,CDM,760,RC,36592,HCPCS,Outpatient,,,165,115.5,,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,103.95,63,,83.16,percent of total Billed charges,63% of Total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total BIlled charges,103.95,63,,83.16,percent of total Billed Charges,63% of total Billed Charges,140.25,85,,112.2,percent of total Billed Charges,85% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,103.95,63,,83.16,percent of total Billed Charges,63% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,103.95,63,,83.16,percent of total billed charges,63% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,132,80,,105.6,percent of total Billed Charges,80% of Total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,102.3,62,,81.84,percent of total Billed Charges,62% of total Billed Charges,102.3,140.25,
51703 - Urinary Catheter Type: Coude,220318,CDM,760,RC,51703,HCPCS,Outpatient,,,280,196,,224,80,,179.2,percent of total Billed Charges,80% of Total Billed Charges,176.4,63,,141.12,percent of total Billed charges,63% of Total Billed Charges,173.6,62,,138.88,percent of total Billed Charges,62% of total BIlled charges,176.4,63,,141.12,percent of total Billed Charges,63% of total Billed Charges,238,85,,190.4,percent of total Billed Charges,85% of total Billed Charges,224,80,,179.2,percent of total Billed Charges,80% of total Billed Charges,173.6,62,,138.88,percent of total Billed Charges,62% of total Billed Charges,176.4,63,,141.12,percent of total Billed Charges,63% of total Billed Charges,173.6,62,,138.88,percent of total Billed Charges,62% of total Billed Charges,176.4,63,,141.12,percent of total billed charges,63% of total Billed Charges,173.6,62,,138.88,percent of total Billed Charges,62% of total Billed Charges,224,80,,179.2,percent of total Billed Charges,80% of Total Billed Charges,173.6,62,,138.88,percent of total Billed Charges,62% of total Billed Charges,173.6,62,,138.88,percent of total Billed Charges,62% of total Billed Charges,173.6,238,
Each Additional 90472,10091,CDM,760,RC,90472,HCPCS,Outpatient,,,46,32.2,,36.8,80,,29.44,percent of total Billed Charges,80% of Total Billed Charges,28.98,63,,23.184,percent of total Billed charges,63% of Total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total BIlled charges,28.98,63,,23.184,percent of total Billed Charges,63% of total Billed Charges,39.1,85,,31.28,percent of total Billed Charges,85% of total Billed Charges,36.8,80,,29.44,percent of total Billed Charges,80% of total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total Billed Charges,28.98,63,,23.184,percent of total Billed Charges,63% of total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total Billed Charges,28.98,63,,23.184,percent of total billed charges,63% of total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total Billed Charges,36.8,80,,29.44,percent of total Billed Charges,80% of Total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total Billed Charges,28.52,39.1,
First Vaccine 90471,10052,CDM,760,RC,90471,HCPCS,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,56.7,63,,45.36,percent of total Billed charges,63% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total BIlled charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total billed charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,76.5,
51700 - Urinary Catheter - Indwelling/Continuous,10053,CDM,760,RC,51702,HCPCS,Outpatient,,,201,140.7,,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,126.63,63,,101.304,percent of total Billed charges,63% of Total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total BIlled charges,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,170.85,85,,136.68,percent of total Billed Charges,85% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,126.63,63,,101.304,percent of total billed charges,63% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,124.62,170.85,
Insertion of temporary indwelling bladder catheter,220318,CDM,760,RC,51703,HCPCS,Outpatient,,,280,196,,224,80,,179.2,percent of total Billed Charges,80% of Total Billed Charges,176.4,63,,141.12,percent of total Billed charges,63% of Total Billed Charges,173.6,62,,138.88,percent of total Billed Charges,62% of total BIlled charges,176.4,63,,141.12,percent of total Billed Charges,63% of total Billed Charges,238,85,,190.4,percent of total Billed Charges,85% of total Billed Charges,224,80,,179.2,percent of total Billed Charges,80% of total Billed Charges,173.6,62,,138.88,percent of total Billed Charges,62% of total Billed Charges,176.4,63,,141.12,percent of total Billed Charges,63% of total Billed Charges,173.6,62,,138.88,percent of total Billed Charges,62% of total Billed Charges,176.4,63,,141.12,percent of total billed charges,63% of total Billed Charges,173.6,62,,138.88,percent of total Billed Charges,62% of total Billed Charges,224,80,,179.2,percent of total Billed Charges,80% of Total Billed Charges,173.6,62,,138.88,percent of total Billed Charges,62% of total Billed Charges,173.6,62,,138.88,percent of total Billed Charges,62% of total Billed Charges,173.6,238,
51701 Straight/Intermittent,51701,CDM,760,RC,51701,HCPCS,Outpatient,,,201,140.7,,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,126.63,63,,101.304,percent of total Billed charges,63% of Total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total BIlled charges,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,170.85,85,,136.68,percent of total Billed Charges,85% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,126.63,63,,101.304,percent of total billed charges,63% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,124.62,170.85,
51702 - Urinary Catheter - Temperature Probe,10080,CDM,760,RC,51702,HCPCS,Outpatient,,,201,140.7,,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,126.63,63,,101.304,percent of total Billed charges,63% of Total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total BIlled charges,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,170.85,85,,136.68,percent of total Billed Charges,85% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,126.63,63,,101.304,percent of total billed charges,63% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,124.62,170.85,
92953 - External Pacing,220085,CDM,760,RC,92953,HCPCS,Outpatient,,,326,228.2,,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,205.38,63,,164.304,percent of total Billed charges,63% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total BIlled charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,277.1,85,,221.68,percent of total Billed Charges,85% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total billed charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,277.1,
51700 - Urinary Catheter Irrigant In,220063,CDM,760,RC,51700,HCPCS,Outpatient,,,431,301.7,,344.8,80,,275.84,percent of total Billed Charges,80% of Total Billed Charges,271.53,63,,217.224,percent of total Billed charges,63% of Total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total BIlled charges,271.53,63,,217.224,percent of total Billed Charges,63% of total Billed Charges,366.35,85,,293.08,percent of total Billed Charges,85% of total Billed Charges,344.8,80,,275.84,percent of total Billed Charges,80% of total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,271.53,63,,217.224,percent of total Billed Charges,63% of total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,271.53,63,,217.224,percent of total billed charges,63% of total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,344.8,80,,275.84,percent of total Billed Charges,80% of Total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,267.22,62,,213.776,percent of total Billed Charges,62% of total Billed Charges,267.22,366.35,
92953 - External Pacing,220085,CDM,760,RC,92953,HCPCS,Outpatient,,,326,228.2,,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,205.38,63,,164.304,percent of total Billed charges,63% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total BIlled charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,277.1,85,,221.68,percent of total Billed Charges,85% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total Billed Charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,205.38,63,,164.304,percent of total billed charges,63% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,260.8,80,,208.64,percent of total Billed Charges,80% of Total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,62,,161.696,percent of total Billed Charges,62% of total Billed Charges,202.12,277.1,
90460: Pediatric First Dose,10101,CDM,761,RC,90460,HCPCS,Outpatient,,,21,14.7,,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.23,63,,10.584,percent of total Billed charges,63% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total BIlled charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,17.85,85,,14.28,percent of total Billed Charges,85% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total billed charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,17.85,
"69209 - Ear, Bilateral",10099,CDM,761,RC,69209,HCPCS,Outpatient,,,224,156.8,,179.2,80,,143.36,percent of total Billed Charges,80% of Total Billed Charges,141.12,63,,112.896,percent of total Billed charges,63% of Total Billed Charges,138.88,62,,111.104,percent of total Billed Charges,62% of total BIlled charges,141.12,63,,112.896,percent of total Billed Charges,63% of total Billed Charges,190.4,85,,152.32,percent of total Billed Charges,85% of total Billed Charges,179.2,80,,143.36,percent of total Billed Charges,80% of total Billed Charges,138.88,62,,111.104,percent of total Billed Charges,62% of total Billed Charges,141.12,63,,112.896,percent of total Billed Charges,63% of total Billed Charges,138.88,62,,111.104,percent of total Billed Charges,62% of total Billed Charges,141.12,63,,112.896,percent of total billed charges,63% of total Billed Charges,138.88,62,,111.104,percent of total Billed Charges,62% of total Billed Charges,179.2,80,,143.36,percent of total Billed Charges,80% of Total Billed Charges,138.88,62,,111.104,percent of total Billed Charges,62% of total Billed Charges,138.88,62,,111.104,percent of total Billed Charges,62% of total Billed Charges,138.88,190.4,
69209 - Ear Irrigation - Left,10098,CDM,761,RC,69209,HCPCS,Outpatient,,,112,78.4,,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,70.56,63,,56.448,percent of total Billed charges,63% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total BIlled charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,95.2,85,,76.16,percent of total Billed Charges,85% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total billed charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,95.2,
69209 - Ear Irrigation - Right,10099,CDM,761,RC,69209,HCPCS,Outpatient,,,112,78.4,,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,70.56,63,,56.448,percent of total Billed charges,63% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total BIlled charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,95.2,85,,76.16,percent of total Billed Charges,85% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total billed charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,95.2,
51701 - Catheterization Bladder,51021,CDM,761,RC,51701,HCPCS,Outpatient,,,201,140.7,,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,126.63,63,,101.304,percent of total Billed charges,63% of Total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total BIlled charges,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,170.85,85,,136.68,percent of total Billed Charges,85% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,126.63,63,,101.304,percent of total Billed Charges,63% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,126.63,63,,101.304,percent of total billed charges,63% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,160.8,80,,128.64,percent of total Billed Charges,80% of Total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,124.62,62,,99.696,percent of total Billed Charges,62% of total Billed Charges,124.62,170.85,
96372 - Injection Medication Intramuscular,51006,CDM,761,RC,96372,HCPCS,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,56.7,63,,45.36,percent of total Billed charges,63% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total BIlled charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total billed charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,76.5,
36556 - Insertion Central Venous Line,536556,CDM,761,RC,36556,HCPCS,Outpatient,,,1734,1213.8,,1387.2,80,,1109.76,percent of total Billed Charges,80% of Total Billed Charges,1092.42,63,,873.936,percent of total Billed charges,63% of Total Billed Charges,1075.08,62,,860.064,percent of total Billed Charges,62% of total BIlled charges,1092.42,63,,873.936,percent of total Billed Charges,63% of total Billed Charges,1473.9,85,,1179.12,percent of total Billed Charges,85% of total Billed Charges,1387.2,80,,1109.76,percent of total Billed Charges,80% of total Billed Charges,1075.08,62,,860.064,percent of total Billed Charges,62% of total Billed Charges,1092.42,63,,873.936,percent of total Billed Charges,63% of total Billed Charges,1075.08,62,,860.064,percent of total Billed Charges,62% of total Billed Charges,1092.42,63,,873.936,percent of total billed charges,63% of total Billed Charges,1075.08,62,,860.064,percent of total Billed Charges,62% of total Billed Charges,1387.2,80,,1109.76,percent of total Billed Charges,80% of Total Billed Charges,1075.08,62,,860.064,percent of total Billed Charges,62% of total Billed Charges,1075.08,62,,860.064,percent of total Billed Charges,62% of total Billed Charges,1075.08,1473.9,
65205 - Removal Foreign Body Eye,51025,CDM,761,RC,65205,HCPCS,Outpatient,,,158,110.6,,126.4,80,,101.12,percent of total Billed Charges,80% of Total Billed Charges,99.54,63,,79.632,percent of total Billed charges,63% of Total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total BIlled charges,99.54,63,,79.632,percent of total Billed Charges,63% of total Billed Charges,134.3,85,,107.44,percent of total Billed Charges,85% of total Billed Charges,126.4,80,,101.12,percent of total Billed Charges,80% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,99.54,63,,79.632,percent of total Billed Charges,63% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,99.54,63,,79.632,percent of total billed charges,63% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,126.4,80,,101.12,percent of total Billed Charges,80% of Total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,97.96,134.3,
65205 - Removal of foreign body external eye; conjunctival superficial;,51025,CDM,761,RC,65205,HCPCS,Outpatient,,,158,110.6,,126.4,80,,101.12,percent of total Billed Charges,80% of Total Billed Charges,99.54,63,,79.632,percent of total Billed charges,63% of Total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total BIlled charges,99.54,63,,79.632,percent of total Billed Charges,63% of total Billed Charges,134.3,85,,107.44,percent of total Billed Charges,85% of total Billed Charges,126.4,80,,101.12,percent of total Billed Charges,80% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,99.54,63,,79.632,percent of total Billed Charges,63% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,99.54,63,,79.632,percent of total billed charges,63% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,126.4,80,,101.12,percent of total Billed Charges,80% of Total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,97.96,62,,78.368,percent of total Billed Charges,62% of total Billed Charges,97.96,134.3,
G0378 - ROOM/BED: Observation,350001,CDM,762,RC,,,Outpatient,,,37,25.9,,29.6,80,,23.68,percent of total Billed Charges,80% of Total Billed Charges,23.31,63,,18.648,percent of total Billed charges,63% of Total Billed Charges,22.94,62,,18.352,percent of total Billed Charges,62% of total BIlled charges,23.31,63,,18.648,percent of total Billed Charges,63% of total Billed Charges,31.45,85,,25.16,percent of total Billed Charges,85% of total Billed Charges,29.6,80,,23.68,percent of total Billed Charges,80% of total Billed Charges,22.94,62,,18.352,percent of total Billed Charges,62% of total Billed Charges,23.31,63,,18.648,percent of total Billed Charges,63% of total Billed Charges,22.94,62,,18.352,percent of total Billed Charges,62% of total Billed Charges,23.31,63,,18.648,percent of total billed charges,63% of total Billed Charges,22.94,62,,18.352,percent of total Billed Charges,62% of total Billed Charges,29.6,80,,23.68,percent of total Billed Charges,80% of Total Billed Charges,22.94,62,,18.352,percent of total Billed Charges,62% of total Billed Charges,22.94,62,,18.352,percent of total Billed Charges,62% of total Billed Charges,22.94,31.45,
G0379 - Direct Admit to Observation,350004,CDM,769,RC,,,Outpatient,,,1050,735,,840,80,,672,percent of total Billed Charges,80% of Total Billed Charges,661.5,63,,529.2,percent of total Billed charges,63% of Total Billed Charges,651,62,,520.8,percent of total Billed Charges,62% of total BIlled charges,661.5,63,,529.2,percent of total Billed Charges,63% of total Billed Charges,892.5,85,,714,percent of total Billed Charges,85% of total Billed Charges,840,80,,672,percent of total Billed Charges,80% of total Billed Charges,651,62,,520.8,percent of total Billed Charges,62% of total Billed Charges,661.5,63,,529.2,percent of total Billed Charges,63% of total Billed Charges,651,62,,520.8,percent of total Billed Charges,62% of total Billed Charges,661.5,63,,529.2,percent of total billed charges,63% of total Billed Charges,651,62,,520.8,percent of total Billed Charges,62% of total Billed Charges,840,80,,672,percent of total Billed Charges,80% of Total Billed Charges,651,62,,520.8,percent of total Billed Charges,62% of total Billed Charges,651,62,,520.8,percent of total Billed Charges,62% of total Billed Charges,651,892.5,
G0009-Medicare Pneumo Admin,10092,CDM,771,RC,,,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,56.7,63,,45.36,percent of total Billed charges,63% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total BIlled charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total billed charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,76.5,
90473: Intranasal/Oral First dose,83850,CDM,771,RC,90473,HCPCS,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,56.7,63,,45.36,percent of total Billed charges,63% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total BIlled charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total billed charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,76.5,
Oral Immun Admin,83855,CDM,771,RC,90473,HCPCS,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,56.7,63,,45.36,percent of total Billed charges,63% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total BIlled charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total billed charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,76.5,
90474: Intranasal/Oral Each additional,90474,CDM,771,RC,90474,HCPCS,Outpatient,,,46,32.2,,36.8,80,,29.44,percent of total Billed Charges,80% of Total Billed Charges,28.98,63,,23.184,percent of total Billed charges,63% of Total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total BIlled charges,28.98,63,,23.184,percent of total Billed Charges,63% of total Billed Charges,39.1,85,,31.28,percent of total Billed Charges,85% of total Billed Charges,36.8,80,,29.44,percent of total Billed Charges,80% of total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total Billed Charges,28.98,63,,23.184,percent of total Billed Charges,63% of total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total Billed Charges,28.98,63,,23.184,percent of total billed charges,63% of total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total Billed Charges,36.8,80,,29.44,percent of total Billed Charges,80% of Total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total Billed Charges,28.52,39.1,
G0008 - Medicare Influenza Admin,10093,CDM,771,RC,,,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,56.7,63,,45.36,percent of total Billed charges,63% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total BIlled charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total billed charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,76.5,
G0009 - Medicare Pneumo Admin,10092,CDM,771,RC,,,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,56.7,63,,45.36,percent of total Billed charges,63% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total BIlled charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total billed charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,76.5,
G0010 - Medicare HepB Admin,83419,CDM,771,RC,,,Outpatient,,,90,63,,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,56.7,63,,45.36,percent of total Billed charges,63% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total BIlled charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,76.5,85,,61.2,percent of total Billed Charges,85% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total Billed Charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,56.7,63,,45.36,percent of total billed charges,63% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,72,80,,57.6,percent of total Billed Charges,80% of Total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,62,,44.64,percent of total Billed Charges,62% of total Billed Charges,55.8,76.5,
90471 IV Push 1st,83855,CDM,771,RC,90471,HCPCS,Outpatient,,,21,14.7,,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.23,63,,10.584,percent of total Billed charges,63% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total BIlled charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,17.85,85,,14.28,percent of total Billed Charges,85% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total billed charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,17.85,
90472 IV Push Subsequent,83856,CDM,771,RC,90472,HCPCS,Outpatient,,,21,14.7,,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.23,63,,10.584,percent of total Billed charges,63% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total BIlled charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,17.85,85,,14.28,percent of total Billed Charges,85% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total Billed Charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.23,63,,10.584,percent of total billed charges,63% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,16.8,80,,13.44,percent of total Billed Charges,80% of Total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,62,,10.416,percent of total Billed Charges,62% of total Billed Charges,13.02,17.85,
Q3014 Consult to BHL,220311,CDM,780,RC,,,Outpatient,,,77,53.9,,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,48.51,63,,38.808,percent of total Billed charges,63% of Total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total BIlled charges,48.51,63,,38.808,percent of total Billed Charges,63% of total Billed Charges,65.45,85,,52.36,percent of total Billed Charges,85% of total Billed Charges,61.6,80,,49.28,percent of total Billed Charges,80% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,48.51,63,,38.808,percent of total Billed Charges,63% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,48.51,63,,38.808,percent of total billed charges,63% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,47.74,65.45,
Q3014 Consult to REACH,220311,CDM,780,RC,,,Outpatient,,,77,53.9,,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,48.51,63,,38.808,percent of total Billed charges,63% of Total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total BIlled charges,48.51,63,,38.808,percent of total Billed Charges,63% of total Billed Charges,65.45,85,,52.36,percent of total Billed Charges,85% of total Billed Charges,61.6,80,,49.28,percent of total Billed Charges,80% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,48.51,63,,38.808,percent of total Billed Charges,63% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,48.51,63,,38.808,percent of total billed charges,63% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,47.74,65.45,
Q3014 Consult to Telehealth,220311,CDM,780,RC,,,Outpatient,,,77,53.9,,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,48.51,63,,38.808,percent of total Billed charges,63% of Total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total BIlled charges,48.51,63,,38.808,percent of total Billed Charges,63% of total Billed Charges,65.45,85,,52.36,percent of total Billed Charges,85% of total Billed Charges,61.6,80,,49.28,percent of total Billed Charges,80% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,48.51,63,,38.808,percent of total Billed Charges,63% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,48.51,63,,38.808,percent of total billed charges,63% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,61.6,80,,49.28,percent of total Billed Charges,80% of Total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,47.74,62,,38.192,percent of total Billed Charges,62% of total Billed Charges,47.74,65.45,
93978 - US Aorta IVC Iliac Duplex Complete,180146,CDM,921,RC,93978,HCPCS,Outpatient,,,465,325.5,,372,80,,297.6,percent of total Billed Charges,80% of Total Billed Charges,292.95,63,,234.36,percent of total Billed charges,63% of Total Billed Charges,288.3,62,,230.64,percent of total Billed Charges,62% of total BIlled charges,292.95,63,,234.36,percent of total Billed Charges,63% of total Billed Charges,395.25,85,,316.2,percent of total Billed Charges,85% of total Billed Charges,372,80,,297.6,percent of total Billed Charges,80% of total Billed Charges,288.3,62,,230.64,percent of total Billed Charges,62% of total Billed Charges,292.95,63,,234.36,percent of total Billed Charges,63% of total Billed Charges,288.3,62,,230.64,percent of total Billed Charges,62% of total Billed Charges,292.95,63,,234.36,percent of total billed charges,63% of total Billed Charges,288.3,62,,230.64,percent of total Billed Charges,62% of total Billed Charges,372,80,,297.6,percent of total Billed Charges,80% of Total Billed Charges,288.3,62,,230.64,percent of total Billed Charges,62% of total Billed Charges,288.3,62,,230.64,percent of total Billed Charges,62% of total Billed Charges,288.3,395.25,
93979 - US Aorta IVC Iliac Duplex Limited,180155,CDM,921,RC,93979,HCPCS,Outpatient,,,334,233.8,,267.2,80,,213.76,percent of total Billed Charges,80% of Total Billed Charges,210.42,63,,168.336,percent of total Billed charges,63% of Total Billed Charges,207.08,62,,165.664,percent of total Billed Charges,62% of total BIlled charges,210.42,63,,168.336,percent of total Billed Charges,63% of total Billed Charges,283.9,85,,227.12,percent of total Billed Charges,85% of total Billed Charges,267.2,80,,213.76,percent of total Billed Charges,80% of total Billed Charges,207.08,62,,165.664,percent of total Billed Charges,62% of total Billed Charges,210.42,63,,168.336,percent of total Billed Charges,63% of total Billed Charges,207.08,62,,165.664,percent of total Billed Charges,62% of total Billed Charges,210.42,63,,168.336,percent of total billed charges,63% of total Billed Charges,207.08,62,,165.664,percent of total Billed Charges,62% of total Billed Charges,267.2,80,,213.76,percent of total Billed Charges,80% of Total Billed Charges,207.08,62,,165.664,percent of total Billed Charges,62% of total Billed Charges,207.08,62,,165.664,percent of total Billed Charges,62% of total Billed Charges,207.08,283.9,
93975 - US Art/Vein Abd/Pelvis/Scrotal Complete,180134,CDM,921,RC,93975,HCPCS,Outpatient,,,474,331.8,,379.2,80,,303.36,percent of total Billed Charges,80% of Total Billed Charges,298.62,63,,238.896,percent of total Billed charges,63% of Total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total BIlled charges,298.62,63,,238.896,percent of total Billed Charges,63% of total Billed Charges,402.9,85,,322.32,percent of total Billed Charges,85% of total Billed Charges,379.2,80,,303.36,percent of total Billed Charges,80% of total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,298.62,63,,238.896,percent of total Billed Charges,63% of total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,298.62,63,,238.896,percent of total billed charges,63% of total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,379.2,80,,303.36,percent of total Billed Charges,80% of Total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,293.88,402.9,
93880 - US Carotid Duplex Bilateral,180145,CDM,921,RC,93880,HCPCS,Outpatient,,,681,476.7,,544.8,80,,435.84,percent of total Billed Charges,80% of Total Billed Charges,429.03,63,,343.224,percent of total Billed charges,63% of Total Billed Charges,422.22,62,,337.776,percent of total Billed Charges,62% of total BIlled charges,429.03,63,,343.224,percent of total Billed Charges,63% of total Billed Charges,578.85,85,,463.08,percent of total Billed Charges,85% of total Billed Charges,544.8,80,,435.84,percent of total Billed Charges,80% of total Billed Charges,422.22,62,,337.776,percent of total Billed Charges,62% of total Billed Charges,429.03,63,,343.224,percent of total Billed Charges,63% of total Billed Charges,422.22,62,,337.776,percent of total Billed Charges,62% of total Billed Charges,429.03,63,,343.224,percent of total billed charges,63% of total Billed Charges,422.22,62,,337.776,percent of total Billed Charges,62% of total Billed Charges,544.8,80,,435.84,percent of total Billed Charges,80% of Total Billed Charges,422.22,62,,337.776,percent of total Billed Charges,62% of total Billed Charges,422.22,62,,337.776,percent of total Billed Charges,62% of total Billed Charges,422.22,578.85,
93306 - US Echo Doppler Complete,180124,CDM,921,RC,93306,HCPCS,Outpatient,,,975,682.5,,780,80,,624,percent of total Billed Charges,80% of Total Billed Charges,614.25,63,,491.4,percent of total Billed charges,63% of Total Billed Charges,604.5,62,,483.6,percent of total Billed Charges,62% of total BIlled charges,614.25,63,,491.4,percent of total Billed Charges,63% of total Billed Charges,828.75,85,,663,percent of total Billed Charges,85% of total Billed Charges,780,80,,624,percent of total Billed Charges,80% of total Billed Charges,604.5,62,,483.6,percent of total Billed Charges,62% of total Billed Charges,614.25,63,,491.4,percent of total Billed Charges,63% of total Billed Charges,604.5,62,,483.6,percent of total Billed Charges,62% of total Billed Charges,614.25,63,,491.4,percent of total billed charges,63% of total Billed Charges,604.5,62,,483.6,percent of total Billed Charges,62% of total Billed Charges,780,80,,624,percent of total Billed Charges,80% of Total Billed Charges,604.5,62,,483.6,percent of total Billed Charges,62% of total Billed Charges,604.5,62,,483.6,percent of total Billed Charges,62% of total Billed Charges,604.5,828.75,
93925 - US Lower Ext Arterial Duplex Bilateral,180130,CDM,921,RC,93925,HCPCS,Outpatient,,,536,375.2,,428.8,80,,343.04,percent of total Billed Charges,80% of Total Billed Charges,337.68,63,,270.144,percent of total Billed charges,63% of Total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total BIlled charges,337.68,63,,270.144,percent of total Billed Charges,63% of total Billed Charges,455.6,85,,364.48,percent of total Billed Charges,85% of total Billed Charges,428.8,80,,343.04,percent of total Billed Charges,80% of total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total Billed Charges,337.68,63,,270.144,percent of total Billed Charges,63% of total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total Billed Charges,337.68,63,,270.144,percent of total billed charges,63% of total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total Billed Charges,428.8,80,,343.04,percent of total Billed Charges,80% of Total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total Billed Charges,332.32,455.6,
93926 - US Lower Ext Arterial Duplex Left,180131,CDM,921,RC,93926,HCPCS,Outpatient,,,474,331.8,,379.2,80,,303.36,percent of total Billed Charges,80% of Total Billed Charges,298.62,63,,238.896,percent of total Billed charges,63% of Total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total BIlled charges,298.62,63,,238.896,percent of total Billed Charges,63% of total Billed Charges,402.9,85,,322.32,percent of total Billed Charges,85% of total Billed Charges,379.2,80,,303.36,percent of total Billed Charges,80% of total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,298.62,63,,238.896,percent of total Billed Charges,63% of total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,298.62,63,,238.896,percent of total billed charges,63% of total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,379.2,80,,303.36,percent of total Billed Charges,80% of Total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,293.88,402.9,
93926 - US Lower Ext Arterial Duplex Right,180131,CDM,921,RC,93926,HCPCS,Outpatient,,,474,331.8,,379.2,80,,303.36,percent of total Billed Charges,80% of Total Billed Charges,298.62,63,,238.896,percent of total Billed charges,63% of Total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total BIlled charges,298.62,63,,238.896,percent of total Billed Charges,63% of total Billed Charges,402.9,85,,322.32,percent of total Billed Charges,85% of total Billed Charges,379.2,80,,303.36,percent of total Billed Charges,80% of total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,298.62,63,,238.896,percent of total Billed Charges,63% of total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,298.62,63,,238.896,percent of total billed charges,63% of total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,379.2,80,,303.36,percent of total Billed Charges,80% of Total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,293.88,402.9,
93970 - US Lower Ext Venous Duplex Bilateral,180002,CDM,921,RC,93970,HCPCS,Outpatient,,,681,476.7,,544.8,80,,435.84,percent of total Billed Charges,80% of Total Billed Charges,429.03,63,,343.224,percent of total Billed charges,63% of Total Billed Charges,422.22,62,,337.776,percent of total Billed Charges,62% of total BIlled charges,429.03,63,,343.224,percent of total Billed Charges,63% of total Billed Charges,578.85,85,,463.08,percent of total Billed Charges,85% of total Billed Charges,544.8,80,,435.84,percent of total Billed Charges,80% of total Billed Charges,422.22,62,,337.776,percent of total Billed Charges,62% of total Billed Charges,429.03,63,,343.224,percent of total Billed Charges,63% of total Billed Charges,422.22,62,,337.776,percent of total Billed Charges,62% of total Billed Charges,429.03,63,,343.224,percent of total billed charges,63% of total Billed Charges,422.22,62,,337.776,percent of total Billed Charges,62% of total Billed Charges,544.8,80,,435.84,percent of total Billed Charges,80% of Total Billed Charges,422.22,62,,337.776,percent of total Billed Charges,62% of total Billed Charges,422.22,62,,337.776,percent of total Billed Charges,62% of total Billed Charges,422.22,578.85,
93971 - US Lower Ext Venous Duplex Left,180003,CDM,921,RC,93971,HCPCS,Outpatient,,,480,336,,384,80,,307.2,percent of total Billed Charges,80% of Total Billed Charges,302.4,63,,241.92,percent of total Billed charges,63% of Total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total BIlled charges,302.4,63,,241.92,percent of total Billed Charges,63% of total Billed Charges,408,85,,326.4,percent of total Billed Charges,85% of total Billed Charges,384,80,,307.2,percent of total Billed Charges,80% of total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total Billed Charges,302.4,63,,241.92,percent of total Billed Charges,63% of total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total Billed Charges,302.4,63,,241.92,percent of total billed charges,63% of total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total Billed Charges,384,80,,307.2,percent of total Billed Charges,80% of Total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total Billed Charges,297.6,408,
93971 - US Lower Ext Venous Duplex Right,180003,CDM,921,RC,93971,HCPCS,Outpatient,,,480,336,,384,80,,307.2,percent of total Billed Charges,80% of Total Billed Charges,302.4,63,,241.92,percent of total Billed charges,63% of Total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total BIlled charges,302.4,63,,241.92,percent of total Billed Charges,63% of total Billed Charges,408,85,,326.4,percent of total Billed Charges,85% of total Billed Charges,384,80,,307.2,percent of total Billed Charges,80% of total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total Billed Charges,302.4,63,,241.92,percent of total Billed Charges,63% of total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total Billed Charges,302.4,63,,241.92,percent of total billed charges,63% of total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total Billed Charges,384,80,,307.2,percent of total Billed Charges,80% of Total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total Billed Charges,297.6,408,
93930 - US Upper Ext Arterial Duplex Bilateral,180132,CDM,921,RC,93930,HCPCS,Outpatient,,,536,375.2,,428.8,80,,343.04,percent of total Billed Charges,80% of Total Billed Charges,337.68,63,,270.144,percent of total Billed charges,63% of Total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total BIlled charges,337.68,63,,270.144,percent of total Billed Charges,63% of total Billed Charges,455.6,85,,364.48,percent of total Billed Charges,85% of total Billed Charges,428.8,80,,343.04,percent of total Billed Charges,80% of total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total Billed Charges,337.68,63,,270.144,percent of total Billed Charges,63% of total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total Billed Charges,337.68,63,,270.144,percent of total billed charges,63% of total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total Billed Charges,428.8,80,,343.04,percent of total Billed Charges,80% of Total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total Billed Charges,332.32,62,,265.856,percent of total Billed Charges,62% of total Billed Charges,332.32,455.6,
93931 - US Upper Ext Arterial Duplex Left,180133,CDM,921,RC,93931,HCPCS,Outpatient,,,474,331.8,,379.2,80,,303.36,percent of total Billed Charges,80% of Total Billed Charges,298.62,63,,238.896,percent of total Billed charges,63% of Total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total BIlled charges,298.62,63,,238.896,percent of total Billed Charges,63% of total Billed Charges,402.9,85,,322.32,percent of total Billed Charges,85% of total Billed Charges,379.2,80,,303.36,percent of total Billed Charges,80% of total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,298.62,63,,238.896,percent of total Billed Charges,63% of total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,298.62,63,,238.896,percent of total billed charges,63% of total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,379.2,80,,303.36,percent of total Billed Charges,80% of Total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,293.88,402.9,
93931 - US Upper Ext Arterial Duplex Right,180133,CDM,921,RC,93931,HCPCS,Outpatient,,,474,331.8,,379.2,80,,303.36,percent of total Billed Charges,80% of Total Billed Charges,298.62,63,,238.896,percent of total Billed charges,63% of Total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total BIlled charges,298.62,63,,238.896,percent of total Billed Charges,63% of total Billed Charges,402.9,85,,322.32,percent of total Billed Charges,85% of total Billed Charges,379.2,80,,303.36,percent of total Billed Charges,80% of total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,298.62,63,,238.896,percent of total Billed Charges,63% of total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,298.62,63,,238.896,percent of total billed charges,63% of total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,379.2,80,,303.36,percent of total Billed Charges,80% of Total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,293.88,62,,235.104,percent of total Billed Charges,62% of total Billed Charges,293.88,402.9,
93970 - US Upper Ext Venous Duplex Bilateral,180002,CDM,921,RC,93970,HCPCS,Outpatient,,,681,476.7,,544.8,80,,435.84,percent of total Billed Charges,80% of Total Billed Charges,429.03,63,,343.224,percent of total Billed charges,63% of Total Billed Charges,422.22,62,,337.776,percent of total Billed Charges,62% of total BIlled charges,429.03,63,,343.224,percent of total Billed Charges,63% of total Billed Charges,578.85,85,,463.08,percent of total Billed Charges,85% of total Billed Charges,544.8,80,,435.84,percent of total Billed Charges,80% of total Billed Charges,422.22,62,,337.776,percent of total Billed Charges,62% of total Billed Charges,429.03,63,,343.224,percent of total Billed Charges,63% of total Billed Charges,422.22,62,,337.776,percent of total Billed Charges,62% of total Billed Charges,429.03,63,,343.224,percent of total billed charges,63% of total Billed Charges,422.22,62,,337.776,percent of total Billed Charges,62% of total Billed Charges,544.8,80,,435.84,percent of total Billed Charges,80% of Total Billed Charges,422.22,62,,337.776,percent of total Billed Charges,62% of total Billed Charges,422.22,62,,337.776,percent of total Billed Charges,62% of total Billed Charges,422.22,578.85,
93971 - US Upper Ext Venous Duplex Left,180003,CDM,921,RC,93971,HCPCS,Outpatient,,,480,336,,384,80,,307.2,percent of total Billed Charges,80% of Total Billed Charges,302.4,63,,241.92,percent of total Billed charges,63% of Total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total BIlled charges,302.4,63,,241.92,percent of total Billed Charges,63% of total Billed Charges,408,85,,326.4,percent of total Billed Charges,85% of total Billed Charges,384,80,,307.2,percent of total Billed Charges,80% of total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total Billed Charges,302.4,63,,241.92,percent of total Billed Charges,63% of total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total Billed Charges,302.4,63,,241.92,percent of total billed charges,63% of total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total Billed Charges,384,80,,307.2,percent of total Billed Charges,80% of Total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total Billed Charges,297.6,408,
93971 - US Upper Ext Venous Duplex Right,180003,CDM,921,RC,93971,HCPCS,Outpatient,,,480,336,,384,80,,307.2,percent of total Billed Charges,80% of Total Billed Charges,302.4,63,,241.92,percent of total Billed charges,63% of Total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total BIlled charges,302.4,63,,241.92,percent of total Billed Charges,63% of total Billed Charges,408,85,,326.4,percent of total Billed Charges,85% of total Billed Charges,384,80,,307.2,percent of total Billed Charges,80% of total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total Billed Charges,302.4,63,,241.92,percent of total Billed Charges,63% of total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total Billed Charges,302.4,63,,241.92,percent of total billed charges,63% of total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total Billed Charges,384,80,,307.2,percent of total Billed Charges,80% of Total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total Billed Charges,297.6,62,,238.08,percent of total Billed Charges,62% of total Billed Charges,297.6,408,
93922 PADNET LIMITED ARTERIAL STDY,150146,CDM,921,RC,93922,HCPCS,Outpatient,,,244,170.8,,195.2,80,,156.16,percent of total Billed Charges,80% of Total Billed Charges,153.72,63,,122.976,percent of total Billed charges,63% of Total Billed Charges,151.28,62,,121.024,percent of total Billed Charges,62% of total BIlled charges,153.72,63,,122.976,percent of total Billed Charges,63% of total Billed Charges,207.4,85,,165.92,percent of total Billed Charges,85% of total Billed Charges,195.2,80,,156.16,percent of total Billed Charges,80% of total Billed Charges,151.28,62,,121.024,percent of total Billed Charges,62% of total Billed Charges,153.72,63,,122.976,percent of total Billed Charges,63% of total Billed Charges,151.28,62,,121.024,percent of total Billed Charges,62% of total Billed Charges,153.72,63,,122.976,percent of total billed charges,63% of total Billed Charges,151.28,62,,121.024,percent of total Billed Charges,62% of total Billed Charges,195.2,80,,156.16,percent of total Billed Charges,80% of Total Billed Charges,151.28,62,,121.024,percent of total Billed Charges,62% of total Billed Charges,151.28,62,,121.024,percent of total Billed Charges,62% of total Billed Charges,151.28,207.4,
93923 - PADNET UPR/LXTR ART STDY 3+ LV,150138,CDM,921,RC,93923,HCPCS,Outpatient,,,280,196,,224,80,,179.2,percent of total Billed Charges,80% of Total Billed Charges,176.4,63,,141.12,percent of total Billed charges,63% of Total Billed Charges,173.6,62,,138.88,percent of total Billed Charges,62% of total BIlled charges,176.4,63,,141.12,percent of total Billed Charges,63% of total Billed Charges,238,85,,190.4,percent of total Billed Charges,85% of total Billed Charges,224,80,,179.2,percent of total Billed Charges,80% of total Billed Charges,173.6,62,,138.88,percent of total Billed Charges,62% of total Billed Charges,176.4,63,,141.12,percent of total Billed Charges,63% of total Billed Charges,173.6,62,,138.88,percent of total Billed Charges,62% of total Billed Charges,176.4,63,,141.12,percent of total billed charges,63% of total Billed Charges,173.6,62,,138.88,percent of total Billed Charges,62% of total Billed Charges,224,80,,179.2,percent of total Billed Charges,80% of Total Billed Charges,173.6,62,,138.88,percent of total Billed Charges,62% of total Billed Charges,173.6,62,,138.88,percent of total Billed Charges,62% of total Billed Charges,173.6,238,
99195 - Therapeutic Phleb,140160,CDM,940,RC,99195,HCPCS,Outpatient,,,468,327.6,,374.4,80,,299.52,percent of total Billed Charges,80% of Total Billed Charges,294.84,63,,235.872,percent of total Billed charges,63% of Total Billed Charges,290.16,62,,232.128,percent of total Billed Charges,62% of total BIlled charges,294.84,63,,235.872,percent of total Billed Charges,63% of total Billed Charges,397.8,85,,318.24,percent of total Billed Charges,85% of total Billed Charges,374.4,80,,299.52,percent of total Billed Charges,80% of total Billed Charges,290.16,62,,232.128,percent of total Billed Charges,62% of total Billed Charges,294.84,63,,235.872,percent of total Billed Charges,63% of total Billed Charges,290.16,62,,232.128,percent of total Billed Charges,62% of total Billed Charges,294.84,63,,235.872,percent of total billed charges,63% of total Billed Charges,290.16,62,,232.128,percent of total Billed Charges,62% of total Billed Charges,374.4,80,,299.52,percent of total Billed Charges,80% of Total Billed Charges,290.16,62,,232.128,percent of total Billed Charges,62% of total Billed Charges,290.16,62,,232.128,percent of total Billed Charges,62% of total Billed Charges,290.16,397.8,
Hyperbaric oxygen (HBO) therapy,10085,CDM,940,RC,99999,HCPCS,Outpatient,,,171,119.7,,136.8,80,,109.44,percent of total Billed Charges,80% of Total Billed Charges,107.73,63,,86.184,percent of total Billed charges,63% of Total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total BIlled charges,107.73,63,,86.184,percent of total Billed Charges,63% of total Billed Charges,145.35,85,,116.28,percent of total Billed Charges,85% of total Billed Charges,136.8,80,,109.44,percent of total Billed Charges,80% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,107.73,63,,86.184,percent of total Billed Charges,63% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,107.73,63,,86.184,percent of total billed charges,63% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,136.8,80,,109.44,percent of total Billed Charges,80% of Total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,106.02,145.35,
Vacuum assisted closure,10085,CDM,940,RC,,,Outpatient,,,171,119.7,,136.8,80,,109.44,percent of total Billed Charges,80% of Total Billed Charges,107.73,63,,86.184,percent of total Billed charges,63% of Total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total BIlled charges,107.73,63,,86.184,percent of total Billed Charges,63% of total Billed Charges,145.35,85,,116.28,percent of total Billed Charges,85% of total Billed Charges,136.8,80,,109.44,percent of total Billed Charges,80% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,107.73,63,,86.184,percent of total Billed Charges,63% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,107.73,63,,86.184,percent of total billed charges,63% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,136.8,80,,109.44,percent of total Billed Charges,80% of Total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,106.02,62,,84.816,percent of total Billed Charges,62% of total Billed Charges,106.02,145.35,
97802 - Medical Nutrition Therapy 15 min Charge,600001,CDM,942,RC,97802,HCPCS,Outpatient,,,99,69.3,,79.2,80,,63.36,percent of total Billed Charges,80% of Total Billed Charges,62.37,63,,49.896,percent of total Billed charges,63% of Total Billed Charges,61.38,62,,49.104,percent of total Billed Charges,62% of total BIlled charges,62.37,63,,49.896,percent of total Billed Charges,63% of total Billed Charges,84.15,85,,67.32,percent of total Billed Charges,85% of total Billed Charges,79.2,80,,63.36,percent of total Billed Charges,80% of total Billed Charges,61.38,62,,49.104,percent of total Billed Charges,62% of total Billed Charges,62.37,63,,49.896,percent of total Billed Charges,63% of total Billed Charges,61.38,62,,49.104,percent of total Billed Charges,62% of total Billed Charges,62.37,63,,49.896,percent of total billed charges,63% of total Billed Charges,61.38,62,,49.104,percent of total Billed Charges,62% of total Billed Charges,79.2,80,,63.36,percent of total Billed Charges,80% of Total Billed Charges,61.38,62,,49.104,percent of total Billed Charges,62% of total Billed Charges,61.38,62,,49.104,percent of total Billed Charges,62% of total Billed Charges,61.38,84.15,
97803 - Reassessment/Intervention 15 min Charge,600002,CDM,942,RC,97803,HCPCS,Outpatient,,,85,59.5,,68,80,,54.4,percent of total Billed Charges,80% of Total Billed Charges,53.55,63,,42.84,percent of total Billed charges,63% of Total Billed Charges,52.7,62,,42.16,percent of total Billed Charges,62% of total BIlled charges,53.55,63,,42.84,percent of total Billed Charges,63% of total Billed Charges,72.25,85,,57.8,percent of total Billed Charges,85% of total Billed Charges,68,80,,54.4,percent of total Billed Charges,80% of total Billed Charges,52.7,62,,42.16,percent of total Billed Charges,62% of total Billed Charges,53.55,63,,42.84,percent of total Billed Charges,63% of total Billed Charges,52.7,62,,42.16,percent of total Billed Charges,62% of total Billed Charges,53.55,63,,42.84,percent of total billed charges,63% of total Billed Charges,52.7,62,,42.16,percent of total Billed Charges,62% of total Billed Charges,68,80,,54.4,percent of total Billed Charges,80% of Total Billed Charges,52.7,62,,42.16,percent of total Billed Charges,62% of total Billed Charges,52.7,62,,42.16,percent of total Billed Charges,62% of total Billed Charges,52.7,72.25,
97804 - Medical Nutrition Therapy Group 30 Min Charge,600003,CDM,942,RC,97804,HCPCS,Outpatient,,,46,32.2,,36.8,80,,29.44,percent of total Billed Charges,80% of Total Billed Charges,28.98,63,,23.184,percent of total Billed charges,63% of Total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total BIlled charges,28.98,63,,23.184,percent of total Billed Charges,63% of total Billed Charges,39.1,85,,31.28,percent of total Billed Charges,85% of total Billed Charges,36.8,80,,29.44,percent of total Billed Charges,80% of total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total Billed Charges,28.98,63,,23.184,percent of total Billed Charges,63% of total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total Billed Charges,28.98,63,,23.184,percent of total billed charges,63% of total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total Billed Charges,36.8,80,,29.44,percent of total Billed Charges,80% of Total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total Billed Charges,28.52,62,,22.816,percent of total Billed Charges,62% of total Billed Charges,28.52,39.1,
10060 Incision  and Drainage Abscess (Simple),700001,CDM,982,RC,10060,HCPCS,Outpatient,,,402,281.4,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,66.72,100,,,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,68.05,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,66.72,68.05,
10061 Incision  and Drainage Complicated/Multiple Charge,10061,CDM,982,RC,700002,HCPCS,Outpatient,,,703,492.1,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,,,
10120 Incision  and removal of Foreign Body Simple Charge,700004,CDM,982,RC,10120,HCPCS,Outpatient,,,399,279.3,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,76.56,100,,,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,78.09,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,76.56,78.09,
"10140 I andD hematoma, seroma, or fluid collection Charge",700005,CDM,982,RC,10140,HCPCS,Outpatient,,,452,316.4,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,80.43,100,,,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,82.04,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,80.43,82.04,
10160 Puncture Aspiration of Abscess Charge,700006,CDM,982,RC,10160,HCPCS,Outpatient,,,367,256.9,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,70.19,100,,,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,71.59,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,70.19,71.59,
10180 I andD Post op Infection Charge,700007,CDM,982,RC,10180,HCPCS,Outpatient,,,686,480.2,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,116.67,100,,,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,119,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,116.67,119,
"11042 Debride, subq tissue - 1st 20 sq. cm Charge",700008,CDM,982,RC,11042,HCPCS,Outpatient,,,233,163.1,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62.57,100,,,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,63.82,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,62.57,63.82,
"11043 Debride, muscle/fascia - 1st 20 sq. cm Charge",700009,CDM,982,RC,11043,HCPCS,Outpatient,,,594,415.8,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,150.54,100,,,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,153.55,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,150.54,153.55,
"11044 Debride, bone - 1st 20 sq. cm Charge",700010,CDM,982,RC,11044,HCPCS,Outpatient,,,876,613.2,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,202.94,100,,,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,207,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,202.94,207,
11055 Trim Skin Lesion Charge,700014,CDM,982,RC,11055,HCPCS,Outpatient,,,61,42.7,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,18.95,100,,,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,19.33,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,18.95,19.33,
11056 Trim 2-4 Lesions Charge,700015,CDM,982,RC,11056,HCPCS,Outpatient,,,86,60.2,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,25.23,100,,,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,25.73,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,25.23,25.73,
11057 Trim > 4 Lesions Charge,700016,CDM,982,RC,11057,HCPCS,Outpatient,,,112,78.4,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,28.01,100,,,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,28.57,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,28.01,28.57,
"11102 Tangential Biopsy of Skin, 1 lesion Charge",700017,CDM,982,RC,11102,HCPCS,Outpatient,,,145,101.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,85.47,100,,,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,87.18,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,85.47,87.18,
"11103 Tangential Biopsy of Skin, each additional lesion Char",700018,CDM,982,RC,11103,HCPCS,Outpatient,,,84,58.8,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,46.1,100,,,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,47.02,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,46.1,47.02,
11104 Punch Biopsy of Skin 1 Lesion Charge,700019,CDM,982,RC,11104,HCPCS,Outpatient,,,180,126,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,107.44,100,,,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,109.59,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,107.44,109.59,
"11105 Punch Biospy of Skin, each additional lesion Charge",700020,CDM,982,RC,11105,HCPCS,Outpatient,,,99,69.3,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,52.83,100,,,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,53.89,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,52.83,53.89,
"11106 Incisional Biopsy of Skin, 1 lesion Charge",700021,CDM,982,RC,11106,HCPCS,Outpatient,,,218,152.6,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,130.04,100,,,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,132.64,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,130.04,132.64,
"11107 Incisional Biopsy of Skin, Each additional lesion Char",700022,CDM,982,RC,11107,HCPCS,Outpatient,,,118,82.6,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,62.29,100,,,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,63.54,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,62.29,63.54,
11719 Trimming of Nondystrophic Nails Charge,700023,CDM,982,RC,11719,HCPCS,Outpatient,,,29,20.3,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,15.58,100,,,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,15.89,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,15.58,15.89,
11730 Remove Nail Plate Charge,700027,CDM,982,RC,11730,HCPCS,Outpatient,,,208,145.6,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,56.51,100,,,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,57.64,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,56.51,57.64,
"11732 Remove Nail Plate, Additional Charge",700028,CDM,982,RC,11732,HCPCS,Outpatient,,,66,46.2,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,27.92,100,,,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,28.48,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,27.92,28.48,
11750 Permanent Nail Removal Charge,700030,CDM,982,RC,11750,HCPCS,Outpatient,,,389,272.3,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,121.76,100,,,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,124.2,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,121.76,124.2,
"15002 Surgical prep-trunk/arm/leg, 1st 100 sq cm Charge",700034,CDM,982,RC,15002,HCPCS,Outpatient,,,846,592.2,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,252.08,100,,,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,257.12,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,252.08,257.12,
15004 Surgical prep-face/hands/feet 1st 100 sq cm Charge,700035,CDM,982,RC,15004,HCPCS,Outpatient,,,998,698.6,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,303.18,100,,,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,309.24,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,303.18,309.24,
"16000 Initial treatment, 1st degree burn(s) Charge",700040,CDM,982,RC,16000,HCPCS,Outpatient,,,179,125.3,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,50.96,100,,,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,51.98,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,50.96,51.98,
"16025 Dsg and/or debride PT burns, int/sub medium (5-10%BSA)",700042,CDM,982,RC,16025,HCPCS,Outpatient,,,430,301,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,95.72,100,,,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,97.63,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,95.72,97.63,
"16030 Dsg and/or debride PT burns, int/sub large (>10%BSA) C",700043,CDM,982,RC,16030,HCPCS,Outpatient,,,430,301,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,120.12,100,,,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,122.52,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,120.12,122.52,
17250 Chemical Cauterization of Granulation Tissue,700044,CDM,982,RC,17250,HCPCS,Outpatient,,,144,100.8,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,33.12,100,,,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,33.78,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,33.12,33.78,
"20220 Biopsy of Bone - superficial, needle Charge",700045,CDM,982,RC,20220,HCPCS,Outpatient,,,333,233.1,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,121.17,100,,,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,123.59,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,121.17,123.59,
"20225 Biopsy of Bone - deep, needle Charge",700046,CDM,982,RC,20225,HCPCS,Outpatient,,,495,346.5,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,113.16,100,,,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,115.42,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,113.16,115.42,
20600 Aspiration/Injection of Small Joint/Bursa Charge,700047,CDM,982,RC,20600,HCPCS,Outpatient,,,139,97.3,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.97,100,,,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,49.95,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,48.97,49.95,
20605 Aspiration/Injection intermediate joint/bursa Charge,700048,CDM,982,RC,20605,HCPCS,Outpatient,,,143,100.1,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,54.08,100,,,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,55.16,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,54.08,55.16,
29445 Total Contact Cast Charge,700052,CDM,982,RC,29445,HCPCS,Outpatient,,,381,266.7,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,184.23,100,,,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,187.91,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,184.23,187.91,
29515 Application of Short Leg Cast Charge,700053,CDM,982,RC,29515,HCPCS,Outpatient,,,192,134.4,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,71.96,100,,,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,73.4,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,71.96,73.4,
29580 Application of unna boot Charge,700054,CDM,982,RC,29580,HCPCS,Outpatient,,,103,72.1,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,48.73,100,,,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,49.7,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,48.73,49.7,
"29581 Application of multilayer venous wnd comp, lower leg C",700055,CDM,982,RC,29581,HCPCS,Outpatient,,,103,72.1,,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,58.15,100,,,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,59.31,102,,,Fee Schedule,102% of GA Medicaid OPPS Rate,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately Reimbursable,,,,,Other,Not Separately Reimbursable,58.15,59.31,
Radilology services,71510,CDM,990,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Radilology services,70819,CDM,990,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Radilology services,70033,CDM,990,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Radilology services,70079,CDM,990,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
Radilology services,70818,CDM,990,RC,,,Outpatient,,,5,3.5,,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.15,63,,2.52,percent of total Billed charges,63% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total BIlled charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,4.25,85,,3.4,percent of total Billed Charges,85% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total Billed Charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.15,63,,2.52,percent of total billed charges,63% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,4,80,,3.2,percent of total Billed Charges,80% of Total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,62,,2.48,percent of total Billed Charges,62% of total Billed Charges,3.1,4.25,
96374- IV Injection single/initial,220178,CDM,0450|0510,RC,96374,HCPCS,Outpatient,,,216,151.2,,172.8,80,,138.24,percent of total Billed Charges,80% of Total Billed Charges,136.08,63,,108.864,percent of total Billed charges,63% of Total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total BIlled charges,136.08,63,,108.864,percent of total Billed Charges,63% of total Billed Charges,183.6,85,,146.88,percent of total Billed Charges,85% of total Billed Charges,172.8,80,,138.24,percent of total Billed Charges,80% of total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total Billed Charges,136.08,63,,108.864,percent of total Billed Charges,63% of total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total Billed Charges,136.08,63,,108.864,percent of total billed charges,63% of total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total Billed Charges,172.8,80,,138.24,percent of total Billed Charges,80% of Total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total Billed Charges,133.92,62,,107.136,percent of total Billed Charges,62% of total Billed Charges,133.92,183.6,
96523 - Central Line Care - Aspirated and flushed,10097,CDM,0761|0360,RC,96523,HCPCS,Outpatient,,,112,78.4,,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,70.56,63,,56.448,percent of total Billed charges,63% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total BIlled charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,95.2,85,,76.16,percent of total Billed Charges,85% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total Billed Charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,70.56,63,,56.448,percent of total billed charges,63% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,89.6,80,,71.68,percent of total Billed Charges,80% of Total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,62,,55.552,percent of total Billed Charges,62% of total Billed Charges,69.44,95.2,